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UNITED STATES OF AMERICA. 



A PRACTICAL TREATISE 



ON 



MATEEIA MEDICA 



AXD 



THERAPEUTICS. 



BY 



ROBERTS BARTHOLOW, M. A., M. D., LL. D., 

Professor of Materia Mediea and General Therapeutics in the Jefferson Medical College of Philadelphia ; 

Fellow of the College of Physicians of Philadelphia ; Member of the American Philosophical 

Society ; President for 1SS1 of the American Neurological Association ; Honorary 

Member of the Ohio State Medical Society, of the Cincinnati Academy of 

Medicine, of the Medical and Chirurgical Faculty of Maryland, etc. ; 

Author of a Treatise on the Practice of Medicine, of a Treatise 

on Medical Electricity, of a Manual of Hypodermic 

Medication, etc. 












FOURTH EDITION REVISED AND ENLARGED. 



SEP 






NEW YOKE: 
D. APPLETON AND COMPANY, 

1, 3, akd 5 BOND STREET. 
1881. 






^ 






^ 



Entered, according to Act of Congress, in the year 1SS1, 

By D. APPLETON AND COMPANY, 
In the Office of the Librarian of Congress, at Washington. 



Entered, according to Act of Congress, in the year 1S79, 

By D. APPLETON AND COMPANY, 
In the Office of the Librarian of Congress, at Washington. 



Entered, according to act of Congress, in the year 1S77, ■ 

By D. APPLETON AND COMPANY, 
In the Office of the Librarian of Congress, at Washington. 



Entered, according to Act of Congress, in the year 1S76, 

By D. APPLETON AND COMPANY, 
In the Office of the Librarian of Congress, at Washington. 



r 



TO THE MEMORY OP 

.FATHER, MOTHER, AND BROTHERS, 

BY THE STJEVIVOK. 



PREFACE TO THE FOURTH EDITION. 



Engagements that admitted of no postponement prevented 
the preparation of the fourth edition of this work at an earlier 
period. Meanwhile, the activity prevailing on all sides in the 
study of experimental and practical therapeutics has contributed 
many new and important facts to this expanding science. New 
remedies, studied by the physiological method, are presented to 
us in the fullest detail of their actions, and old ones are exam- 
ined anew in the brilliant light of modern scientific methods. 
Subjected to the strictest physiological tests, remedies are pur- 
sued into the closest recesses of Nature, their powers fully ascer- 
tained, and their uses suggested from the standpoint of their 
physiological actions. The old facts thus receive sifting and re- 
examination, and, with the new, demand recognition and ade- 
quate statement. It follows, that any therapeutical treatise which 
would keep pace with the progress of knowledge must be fre- 
quently renewed, amended, and improved. Appreciating fully the 
necessity for this periodical revision of my treatise, I have care- 
fully reviewed the acquisitions of the period intervening since the 
publication of the last edition, and have in the present edition in- 
corporated those improvements in our therapeutical resources which 
seem to be of permanent value. I have revised the text at all 
points, have rewritten many articles, made important additions to 
others, and have inserted, for the first time, the articles on Ba- 
rium, Nitro-glycerine, Curara, Muscarine, Hesorcin, etc. The 
group Antiseptics has been transferred to a more appropriate 



vi PREFACE TO THE FOURTH EDITION. 

position, among the systemic remedies. The growing importance 
in modern pathology of the germ theory requires this group- 
ing of certain remedies possessing the power to destroy the mi- 
nute organisms of disease, and to arrest septic processes. These 
properties are sufficiently distinctive to require their recognition in 
a separate group ; but, in addition, the remedies composing this 
group have antipyretic effects. It has been suggested that the 
antiseptic action is the source of the antipyretic — that in the 
destruction of germs, or morbific ferments, lies the power to 
arrest the excess in heat-production. 

Notwithstanding the numerous and important additions to 
the work, the number of pages has been increased only about 
seventy. In several instances important additions have been 
made, without any increase of space, by the sacrifice of the ref- 
erences. In the rewriting of old articles and in the preparation 
of the new, the utmost conciseness consistent with clearness and 
accuracy has been the ruling principle. True to the idea ex- 
pressed ifi the first edition, I have, as far as possible, accepted 
the results of physiological research, but have not ignored the 
facts obtained empirically. Unquestionably, the tide of thera- 
peutical knowledge sets strongly in the direction indicated by the 
former, and the latter is as distinctly ebbing outward. On all 
sides the conviction is growing, that the real and permanent 
advances in therapeutical art must be effected chiefly by the 
physiological method. Nevertheless, empirical facts of undoubted 
value are occasionally brought forward. In "the shapeless mass 
of inexact ideas," as Bichat entitled empirical observations, there 
are often found genuine therapeutical gems. 

Besides the careful revision given to the whole work, I have 
rewritten the " Clinical Index," with a view to the addition of 
new matter, and to secure greater accuracy of expression. Pre- 
scriptions which heretofore had a place in this index, and were 
transcribed from the body of the work, have been omitted, as 
their repetition seemed unnecessary, and gave opportunity for 
serious errors. The page reference permits the easy finding of a 
formula, and in the search the context will be read, so that with 
the prescription will be obtained needful explanations. 






PREFACE TO THE FOURTH EDITION. vii 

n submitting this edition to my professional colleagues, I 
am again afforded the grateful opportunity to express my sincere 
appreciation of the favor with which each formal edition has 
been, received. I must also repeat my acknowledgments to the 
kind correspondents who have informed me of errors, textual 
and typographical, coming under their notice, and I now thank 
in advance any one of my readers who, observing an error of 
any kind, will inform me of it. 

K. B. 

Philadelphia, September 1, 1881. 




PREFACE TO THE THIRD EDITION. 



In the preparation of this edition, I have made changes de- 
manded by the progress of knowledge, have omitted obsolete or 
unnecessary statements, and have added some entirely new articles. 
As examples of the additions made, I may mention the articles on 
Air, Massage, and Duboisia. The text has been thoroughly re- 
vised, and typographical and other errors corrected. Notwith- 
standing considerable additions, the volume is kept nearly within 
its original limits, by condensing the new material to the lowest 
point consistent .with clearness of statement and fullness and accu- 
racy of information. 

The rapid sale of successive editions of the work is the most 
conclusive evidence of its adaptation to the needs of students and 
practitioners. To make it still more worthy of their approval has 
been my constant endeavor, as the best and most appropriate ex- 
pression of my gratitude for the extraordinary favor with which 
the treatise has been regarded since its first appearance. 

E. B, 

1509 Walnut Street, Philadelphia. 



PKEFACE TO THE SECOND EDITION. 



The success of my treatise has exceeded any reasonable expec- 
tations, and, under the circumstances, is peculiarly gratifying. Con- 
structed on a somewhat different plan from the ordinary text-books, 
and brought into direct competition with several very able and well- 
established works on the same subject, I could not but feel that its 
progress to professional favor must necessarily be slow. That sev- 
eral considerable editions have been exhausted in the first year of 
its publication, and that the demand for the book has not abated, 
indicate that its appearance was opportune, and that its plan and 
execution are approved by the medical profession. 

In this new edition various improvements have been made, and 
articles on the following subjects have been inserted : 



Beverages. 


Heat. 


Digestion-Ferments 


Vegetable Acids. 


Cadmium. 


Cerium. 


Picrotoxine. 


Cannabis Indica. 


Cuca. 


Caffein. 


Guar an a. 


Pulsatilla. 


Grindelia. 


Phytolacca. 


Ailantus. 



Besides the new articles, additions have been made at various 
points. Notwithstanding these additions, the bulk of the work has 
not been materially increased, and its practical character has been 
strictly maintained. 

Increasing observation satisfies me that an author, writing on 
such a complicated topic as the actions and uses of remedies, owes 
it to his readers to present them the results of his matured experi- 
ence and his most composed judgment, rather than lay before them 
a multitude of opinions, experiments, and reports, out of which 
they must construct, if they can, a consistent theory, or form an 



X PREFACE TO THE SECOND EDITION. 

v 

adequate conception of the nature and relations of all the facts. 
But few readers will give the time to so tedious a task, and the 
smallest number are fitted by education, training, and habits of 
mind, for working out results from such a complicated mass of 
materials. While every author is bound to indicate to his readers 
the sources of his information, it is equally his duty to present that 
information in the form most available for immediate use. 

The classification of remedies must continue in an unsatisfac- 
tory state, and any scientific scheme is, at present, hopeless. The 
distinguished and able Prof. Edward H. Clark, M. D., of Harvard 
(Boston), in his review of this work {The American Journal of the 
Medical Sciences, January 7, 1877), justly remarks as follows : 

" ~So scientific classification of the materia medica is possible in the present 
state of science. "Writers are, therefore, justified in adopting any classification 
that may happen to suit their fancy, or in adopting none at all." 

Notwithstanding a scientific arrangement is unattainable, it is 
certainly convenient to group together those agents which are phys- 
iologically and therapeutically allied. I have adopted, in part, the 
classification proposed, in 1863, by Dr. Chambers ("Renewal of 
Life," etc.), using the two great divisions of "agents promoting 
constructive metamorphosis " and " agents promoting destructive 
metamorphosis." As respects the assignment of individual reme- 
dies, in accordance with certain conceptions of their powers and 
actions, the arrangement adopted is entirely my own. 

The omission of certain botanical, chemical, and pharmaceutical 
details, except such as are necessary to a just appreciation of the 
physiological actions, or to " facilitate intelligent prescription-writ- 
ing," has been decidedly commended by the reviewers, and by my 
readers generally. In the present state of pharmacy, knowledge 
of the kind omitted would prove useless, in the main, to physicians, 
even if acquired. I beg, however, to call the attention of my 
readers to the fact that the official designation of the remedy, its 
pharmaceutical preparations, its chemical composition, and its 
active principles, are carefully stated, and should be mastered by 
every student. This knowledge of the technih of his armamen- 
tarium is an indispensable requisite to its skillful use. 




PREFACE TO THE SECOND EDITION. \i 

The author has a strong conviction that, in the future of thera- 
peutics, the law or principle of physiological antagonism must play 
an important role. He has indicated more fully, probably, than 
any other systematic writer, the application of this principle in 
practical therapy. 

In the preparation of the articles I have studiously endeavored 
to preserve the harmony and proportion of the parts, and have 
treated them with a fullness and particularity according to their 
relative importance. In this way it may appear to some of my 
readers that I have exaggerated some topics, and have treated 
others, equally important, with indifference. Having given careful 
consideration to this subject in the course of my preparations for 
the new edition, I conclude that the judgments formed in the first 
instance are confirmed by more extended study and observation. 

Any one discovering an error of any kind in this edition of my 
treatise will place me under great obligations by reporting it to me 
without delay. 

I am indebted to my assistant, Dr. Frederic Kebler, for the re- 
vision of the indexes. 

KOBERTS BARTHOLOW. 

120 West Seventh Steeet, Cincinnati. 



PEEFACE TO THE FIEST EDITION. 



To offer to the medical profession a new treatise on Materia 
Medica and Therapeutics may appear to be a labor of supererogation. 
The medical literature of this country is already well provided with 
able and elaborate works on this subject. The learned and encyclo- 
pedic volumes of Stille, based on the empirical method, and the 
modern and scientific work of H. C. Wood, based on the physio- 
logical method, leave almost nothing to be desired. Entertaining 
such a profound respect for the work of my American colleagues, 
it may well be inquired why I have ventured to add a new book to 
those already existing in this department of medical knowledge. 
A belief, which I trust will not be regarded as egotism, that I have 
earned the right to address the medical profession, has moved me 
to the preparation of this work. Several years a teacher of Materia 
Medica and Therapeutics, I have necessarily formed opinions as to 
the kind of information which should be contained in a treatise on 
this subject. As far as such a course of experiment is practicable, 
I have demonstrated in my lectures the actions of remedies on ani- 
mals. I have conducted in my private laboratory many indepen- 
dent investigations, and have contributed in this way, 1 submit with 
diffidence, some original knowledge to the subject of therapeutics. 
The information thus acquired has been supplemented by twenty- 
two years of clinical experience as a practitioner of medicine. Un- 
der these circumstances, I am induced to believe that my professional 
brethren, and medical students, will hold that I am entitled to a 
hearing. 

A volume on Materia Medica and Therapeutics should, in these 
days, present some new features of importance if it would worthily 
occupy a place alongside of the excellent works now accessible to 
American readers. An examination of this treatise will disclose the 
fact that it differs from other works in its scheme of classification, 
in the subjects discussed, and in the very practical character of the 



PREFACE TO THE FIRST EDITION. xiii 

information. In the present state of our knowledge, it is impossible 
to make a. classification free from defects, and I do not claim for 
mine that it is superior to others — only that its simplicity is a point 
in its favor. As respects the subjects treated of, it will be seen that 
the most elaborate section is that on aliment, and that remedies have 
been introduced not usually referred to by therapeutical writers. 
In the treatment of individual agents, I have, usually, adopted the 
description of the " United States Pharmacopoeia," and have omitted 
botanical and chemical details, unless they are necessary to elucidate 
physiological questions, or to facilitate intelligent prescription-writ- 
ing. All pharmaceutical questions are most thoroughly handled in 
the "Dispensatory" of Wood and Bache, and this kind of knowl- 
edge is more the province of the druggist than of the physician. 

In describing the physiological action of drugs, two methods 
may be pursued : to present in chronological order a summary of 
the opinions of various authorities on the subject in question; or, 
to condense in a connected description that view of the subject 
which seems to the author most consonant with all the facts. I have 
adopted the latter plan, from a conviction of its advantages for the 
student, and of its utility for the practitioner. The authorities 
which I have utilized in making up my opinions are placed at the 
end of each article, in order to avoid interruptions in the methodical 
descriptions. 

As respects the therapeutical applications of remedies, I have, as 
far as practicable, based them on the physiological actions. Many 
empirical facts are, however, well founded in professional experience. 
Although convinced that the most certain acquisitions to therapeu- 
tical knowledge must come through the physiological method, I am 
equally clear that well-established empirical facts should not be 
omitted, even if they are not explicable by any of the known physi- 
ological properties of the remedies under discussion. 

My best acknowledgments are due to John Chatto, Esq., the 

learned Librarian of the Royal College of Surgeons, London, for 

numerous courtesies extended to me during my visits to Lincoln's- 

Inn-Fields. 

Roberts Bartholow. 

120 West Seventh Street, i 

CnromsATi, Ohio, June, 1876. J 



TABLE OF CONTENTS. 



Schema 



PAdE 

1 



PART I. 

Routes by which Medicines are introduced into the Organism 

1. Through the External Integument . 

2. Through the Internal Integument 

3. By the Subcutaneous Areolar Tissue 

4. By the Veins • . 

Transfusion of Blood .... 
Arterial Transfusion ..... 
Transfusion of Milk 
Peritoneal Transfusion .... 



4 
10 
12 
13 
16 
16 
17 



PART II. 

The Actions and Uses of Remedial Agents 
Those used to promote Constructive Metamorphosis 
Aliments 
Animal 
Vegetable . 
Special Plans of Diet 
Denutrition 
Dry Diet 
Vegetable Diet 
Milk Diet 
Infant Feeding 
Alimentation in Diseases . 

Aliment in Acute Inflammations and Fevers 
Formulae for Animal Broths 
Formulae for Diet Drinks 
Aliment in Diseases of the Digestive Organs 
Aliment in Cachectic States 

Formulae for Articles of Diet 
Nutrient Enemata 

Supplementary Rectal Alimentation 
Beverages ..... 
Coffee ..... 
Tea 



19 

19 
19 
21 
29 
33 
34 
36 
37 
39 
42 
44 
44 
45 
45 
46 
47 
49 
50 
51 
51 
51 
52 



XVI 



TABLE OF CONTENTS. 



Cocoa . 
Milk 
Water 
Aqua 

Fluvialis . 
Fontana 
Modes of applying Water 
Russian Bath 
The Wet Pack . 
The Douche . 
The Hip or Sitz Bath 
Hydrotherapy 
neat 

Modes of applying Heat . 
Solar Heat 
Artificial Heat 
Moist Heat 
Dry Heat 
The Turkish Bath 
Air . 

Pure Air 
Impure Air 
Compressed Air 

Therapy of Compressed Air 
Massage 

Digestion Ferments 
Pepsin . 
Ingluvin . 
Pancreatine 
Acidum Lacticum 
Acids, Mineral 
Oils and Fats . 
Phosphorus and some of its Compound 
Phosphites and Phosphates 
Iron and its Preparations . 
Manganesium . 

Chalybeate Mineral Springs 
Bismuth 
Arsenic 

The Simple Bitters 
Aromatic Bitters 
Eucalyptus 
Hydrastis . 

Cinchona and its Preparations . 
Agents promoting Destructive Mctamorph 
Alkalies 

Potassium and its Preparations 
Sodium and its Preparations 
Calcium and its Preparations . 
Lithium and its Preparations 
Alkaline Mineral Springs 
Saline Mineral Springs 



ing Waste 



PAGE 

52 

53 

54 

54 

54 

54 

57 

57 

53 

53 

59 

59 

C7 

63 

08 

69 

09 

09 

C9 

71 

72 

72 

73 

76 

7S 

81 

81 

81 

82 

83 

87 

95 

102 

111 

115 

127 

430 

133 

135 

148 

151 

153 

155 

158 

178 

178 

.178 

1S5 

188 

1S9 

193 

195 






TABLE OF CONTENTS. 



XVII 





PAGE 


Ammonium and its Preparations . 


. 199 


Barium and its Preparations .... 


205 


Vegetable Acids ...... 


. 207 


Sulphurous Acid and the Sulphites ... 


209 


Sulphides (Sulphurets) . 


. 211 


Sulphurous Mineral Waters .... 


213 


Iodine and its Preparations . . . . . 


. 216 


Mercury and its Preparations .... 


227 


Aurum (Gold) and its Preparations . . . . 


. 239 


Argcntum (Silver) and its Preparations . 


241 


Cuprum (Copper) and its Preparations 


. 249 


Plumbum (Lead) and its Preparations 


253 


Zincum (Zinc) and its Preparations . . . . 


. 258 


Antimonium (Antimony) and its Preparations 


263 


Cadmium, Sulphate ...... 


. 268 


Cerium, Oxalate . • . 


269 


Alumen (Alum) and its Preparations . . . . 


. 269 


Acidum Tannicum 


272 


Acidum Gallicum . . . ... 


. 273 


Galla (Nutgall) 


273 


Catechu ........ 


. 273 


Kino ....... 


273 


Krameria (Rhatany) ...... 


. 273 


Ilamiatoxylon (Logwood) ..... 


274 


Geranium (Cranesbill) . . . . . 


. 271 


Qucrcus Alba (White Oak) .... 


274 


Quercus Tinctoria (Black Oak) . 


. 274 


Rosa Gallica (Red Rose) . . . 


274 


Rubus (Blackberry) ...... 


. 274 


Myrica Cerifera (Bayberry) ... 


274 


Alnus Serrulata (Alder) . 


. 275 


Statice Limonium (Marsh Rosemary) 


275 


Ileuchera (Alum Root) . 


. 275 


Ilamamelis Yirginica (Witch Hazel) 


275 


Nympha:a Odorata ...... 


. 275 


Castanea Vesca ...... 


275 


Colchicum and its Preparations . . . . 


. 281 


Sarsaparilla and its Preparations .... 


284 


Guaiacum and its Preparations 


. 285 


Stillingia and its Preparations .... 


287 


Xanthoxylum ....... 


. 291 


Agents used to Modify the Functions of the Nervous System 


293 


Agents whose most Important Quality consists in exciting Functio 


nal Activity . 293 


A. Of the Spinal Cord and Sympathetic 


293 


Electricity ....... 


. 293 


Galvanism ...... 


294 


Faradisra ....... 


. 295 


Electrolysis ...... 


307 


Galvano-Cautery ...... 


. 307 


Static Electricity ..... 


309 


Trouve's Polyscope . 


. 309 


Nux Vomica and its Preparations 


310 



XV111 



TABLE OF CONTENTS. 



Hypodermatic Injection of Strychnia 
Picrotoxine ..... 

Ergota (Ergot) and its Preparations . 
Ustilago Maidis (Corn Ergot) 

Hypodermatic Injection of Ergotin 
Digitalis and its Preparations 
Cimicifuga and its Preparations 
Belladonna and its Preparations . 

Atropia ..... 

Atropia, Hypodermatic Injection of . 
Stramonium and its Preparations 
Hyoscyamus and its Preparations 
Duboisia ..... 

B. Agents exciting the Functional Activity of the Cerebrum 
Camphor and its Preparations 
Asafoetida and its Preparations . 
Ammoniacum and its Preparations . 
Valerian and its Preparations 
Serpentaria and its Preparations 
Cannabis Indica ..... 

Cannabis Americana .... 

Coca or Cuca ..... 

Caffein ..... 

Remedies which diminish or suspend the Functions of the Cerebrum after 
Preliminary Stage of Excitement . 
Alcohol ...... 

Vinum (Wine) . 

Beer, Ale, and Porter .... 

JEther ....... 

Chloroformum ...... 

Chlorodync ..... 

Anaesthetics and Anaesthesia . ... 

Local Anaesthesia ..... 

Nitrous Oxide ..... 

Chloral 

Croton Chloral Hydrate .... 

Opium and its Preparations . 

Morphia and its Salts .... 

Humulus (Hops) . • . 

Lupuline ..... 

Lactucarium . . . .- 

Bromides .....". 

Agents which depress the Motor Functions of the Spinal Cord and Sympathetic, 
Conium and its Preparations 

Conia and Morphia .... 

Curara or Woorara .... 

Curarine ...... 

Gelsemium and its Preparations 

Arnica and its Preparations .... 

Trimethylamine ..... 

Pilocarpus (Jaborandi) .... 

Physostigma and its Preparations . 



TABLE OF CONTENTS. 



XIX 





PAGE 


Tabacum (Tobacco) and its Preparations .... 


477 


Lobelia and its Preparations ...... 


. 481 


Aeidum Hydrocyanicuni (Prussic Acid) .... 


484 


Potassii Cyanidum ....... 


. 487 


Amyl Nitrite ........ 


489 


Nitro-glycerine ........ 


. 491 


Aconite and its Preparations ...... 


494 


Veratrum Viride and its Preparations . 


. 499 


Pulsatilla and its Preparations .... 


504 


Grindelia and its Preparations ...... 


. 505 


Phytolacca and its Preparations ..... 


506 


Ailanthus ......... 


. 508 


Muscarine ........ 


508 


Agents having the Power to arrest Septic Processes and to destroy the 


Minute 


Organisms, on the Presence of whicb their Activity depends . 


. 513 


Oxygenium (Oxygen) ....... 


513 


Chlorine . . . . ... 


. 515 


Bromine ........ 


516 


Carbolic Acid . . . 


. 517 


Creosote ........ 


. 517 


Sulpho-Carbolates ...... 


. 527 


Salicin ......... 


528 


Salicylic Acid ....... 


. 529 


Resorcin ........ 


540 


Boracic Acid ....... 


. 542 


Benzoin and its Preparations . . . 


544 


Antiseptic Oils ........ 


. 546 


Thymol ........ 


547 


Myrtol . . . . 


. 548 


Remedies used to cause some Evacuation from tbe Body 


549 


Emetics ........ 


. 549 


Emetics by Local Action ...... 


549 


Systemic Emetics ...... 


. 551 


Apomorpbia . ... 


551 


Ipecacuanha and its Preparations 


. 553 


Cathartics ........ 


558 


Laxatives . . ... 


. 559 


Manna ....... 


559 


Sulphur ....... 


. 559 


Pulvis Glycyrrhizte Compositus .... 


560 


Magnesia ....... 


. 560 


Oleum Ricini ....... 


561 


Saline Purgatives ...... 


. . 562 


Sulphate of Magnesia ..... 


562 


Citrate of Magnesia ..... 


. 562 


Mercurial Purgatives . 


565 


Calomel ....... 


. 565 


Pil. Hydrargyri ...... 


565 


Tonic-Astringent and Resin-bearing Purgatives 


. 566 


Senna and its Preparations ..... 


666 


Rheum and its Preparations .... 


. 567 


Aloes and its Preparations . . . ... 


569 



XX 



TABLE OF CONTENTS. 



Jalap and its Preparations 
Scammony and its Resin 
Colocynth and its Preparations 
Podophyllum and its Preparations 
Leptandra 
Iris 

Euonymus 
Hydragogue Cathartics 
Gamboge . 
Croton Oil 
Elaterium 
Enemata . 
Anthelmintics . 
Mercury 
Santonica . 

Santonine 
Spigelia and its Preparations 
Chenopodium (Worm-Seed) 

Oleum Chenopodii 
Felix Mas (Male Fern) 
Oleoresina Felicis 
Granati Fructus Cortex 
Brayera . 
Eottlera 

Pepo (Pumpkin Seeds) 
Urino-Genital Remedies . 
Oleum Terebinthinae 
Copaiba and its Preparations . 
Cubeb and its Preparations 
Piper .... 

Oleoresina Piperis 
Capsicum and its Preparations 
Juniper and its Preparations 
Erigeron 

Oleum Erigerontis 
Buchu and its Preparations 
Uva TJrsi and its Preparations 
Pareira and its Preparations . 
Chimiphila and its Preparations 
Scoparius 
Carota 

Taraxacum and its Preparations 
Scilla and its Preparations . 
Petroselinum . 
Polygonum Hydropiperoides 
Ruta .... 
Sabina 
Cantharis 

Tinctura Cantharidis . 



PAGE 

572 
673 
573 
574 
575 
576 
576 
576 
576 
577 
579 
580 
582 
583 
583 
5S3 
585 
585 
585 
586 
586 
586 
5S7 
5S7 
587 
588 
588 
593 
696 
597 
597 
597 
599 
600 
600 
600 
600 
600 
601 
601 
601 
602 
602 
604 
605 
606 
606 
608 
608 






TABLE OF CONTENTS. 



XXI 



PART III. 

Topical Remedies. .... 

Counter-irritants .... 
Rubefacients .... 

Rinapia Alba 

Sinapis Nigra 

Charta Sinapis 
Epispastics .... 

Ceratum Cantharidis 

Ceratum Extract i Cantharidis 

Charta Cantharide 

Collodium Cum Cantharidis . 

Linimentum Cantharidis . 
Acupuncture .... 

Baunscheidtismus 

Aquapuncturc .... 
Bloodletting .... 
Eschartics .... 

Acidum Chromicum 
Emollients, Protectives, and Demulcents . 

Glycerine and its Preparations . 

Collodium .... 

Licpjor Gutta-Percha 

Chondrus (Irish Moss) 

Cctraria (Iceland Moss) . 

Acacia and its Preparations . 

Tragacanth 

Mucilago Tragacanthae . 

Sassafras Medulla? 

Mucilago Sassafras Medullae 

Linum (Flaxseed) and its Preparations 

Ulmus (Slippery Elm) 
Mucilago Ulrai 

Glveyrrhiza and its Preparations 
Poultices .... 



PAOB 

610 
610 
610 
610 
610 
610 
612 
612 
612 
612 
612 
612 
616 
616 
616 
618 
620 
621 
622 
022 
623 
624 
625 
625 
625 
625 
625 
625 
625 
626 
626 
688 
626 
626 



A TEEATISE 



ON 



MATERIA MEDICA AND THERAPEUTICS. 



SCHEMA. 

Part I. — 3/odes in which 3Iedicin.es are introduced into the Or- 
ganism. 

Part II. — The Actions and Uses of Remedial Agents : 

Those used to promote constructive metamorphosis. 

Those used to promote destructive metamorphosis. 

Those used to modify the functions of the nervous system. 

Those used to prevent septic decomposition. 

Those used to cause some evacuation from the body. 

Part III. — Topical Remedies. 

In this scheme the action of the medicine is followed from its intro- 
duction into the stomach, to its exit through the organs of excretion. 
Some remedies are used solely or chiefly for their influence on the pri- 
mary assimilation ; as, for example, pepsin, the simple bitters. Other 
remedies, with or without affecting the function of digestion, modify 
the process of assimilation, either promoting the construction of tissue, 
or the retrograde or destructive metamorphosis. Iron may be taken 
as a t}rpical example of the one, and mercury of the other mode of 
action on the function of assimilation. The therapeutical application 
of these remedies is based in this conception of their physiological 
action. 

A large group of remedial agents is used not to influence the meta- 
morphosis of tissue, but simply to modify the functions of the nervous 
system, of which morphia and strychnia may be taken as types. It ia 
true that probably no medicinal agent modifying function does so with- 
out affecting structure ; but, in the present state of our knowledge, we 
are, in respect to some of them at least, unable to designate the tissue- 
changes which they induce. 
2 



2 SCHEMA. 

In the group of those agents used to prevent septic decomposition 
are included remedies having a destructive action on the minute 
organisms, or germs of disease. These remedies have, also, distinct 
antipyretic effects, and a relation probahly exists between the anti- 
ferment action and the power to reduce febrile heat. The members 
of this group are mostly phenols. Quinia belongs to it, but is more 
suitably studied elsewhere, with cinchona and its preparations. 

To the class of evacuants belong emetics, cathartics, anthelmintics, 
and diuretics. These remedies are either so irritant as to excite speedy 
action for their expulsion, or they are eliminated by the organs on which 
they appear to have a selective effect. "When the movement for their 
expulsion terminates, as a rule their action ceases. Some of these irri- 
tant emetics and cathartics, acting locally merely, might be classed with 
topical remedies, but such an arrangement would destroy the continuity 
of the subject. 

Topical remedies act upon the part to which they are applied. Ab- 
sorption is not necessary to, and indeed hinders the local effect ; hence, 
any systemic effects produced by them are accomplished through the 
agency of the nervous system. 



PART I. 

ROUTES BY WHICH MEDICINES ARE INTRODUCED 
INTO THE ORGANISM. 



I. 

THROUGH THE EXTERNAL INTEGUMENT. 

By this tissue medicines are applied in the following modes : 

Enepidermic. 

Epidermic. 

Endermic. 

Enepidermic. — In this method, the medicament is placed in contact, 
only, with the epidermis, and friction, to hasten absorption, is not em- 
ployed. Although the epidermis opposes a strong obstacle to absorp- 
tion, it does not entirely prevent diffusion into the blood, as numerous 
facts show. The skin may be considered a colloidal septum. The rate 
and degree of absorption of any medicine will depend, in large part, on 
its power of diffusion. Various circumstances influence this — for exam- 
ple, the chemical position of the agent to be diffused. On one side of 
the colloidal septum — the skin — lie the blood-vessels, containing an 
alkaline fluid. An acid fluid on one side of the osmotic membrane, 
and an alkaline fluid on the other, are conditions most favorable to 
osmosis. Experiments are wanting on this point, but it is a reasonable 
presumption that solutions of medicinal substances, acid in reaction, 
will find their way most readily into the blood. 

Besides the epidermis, the sebaceous matter of the skin offers more 
or less positive obstruction to cutaneous absorption. Medicinal sub- 
stances in solution in water, therefore, very slowly permeate the skin to 
enter the vessels. Waller, who has made very careful experiments, has 
ascertained that alkaloids dissolved in chloroform are readily transferred 
through the skin into the blood, and produce characteristic pheuomena, 
while " alcoholic and aqueous solutions are either not at all, or very 
slowly, absorbed." 



£ HOW MEDICINES ARE INTRODUCED. 

His observations were made with chloroformic solutions of aconite, 
atropia, strychnia, and morphia. Waller further ascertained that alco- 
hol mixed with chloroform did not retard absorption, but alcohol alone 
caused an outward osmotic flow. It follows from these facts that, if, in 
the application of a medicinal agent to the skin by the endermic 
method, the object be to promote absorption, the remedy should be 
dissolved in chloroform, or in a mixture of alcohol and chloroform, and 
not in alcohol alone, or in water. 

Epidermic. — This method differs from the enepidermio in that fric- 
tion 13 employed to promote absorption by forcing the medicament 
between the cells of the epidermic layer. Various agents are used in 
this way, as mercurial ointment in syphilis, cod-liver oil, and other fats, 
in wasting diseases, and ointments of various kinds for the relief of 
local lesions, etc. The evidence is conclusive that in this way systemic 
effects are produced. 

Endermic. — As the epidermis is the chief obstacle to cutaneous 
absorption, it is sometimes removed by blistering, so that the medica- 
ment may come into immediate contact with the derma. The mode of 
proceeding by the endermic method is as follows : a piece of flannel, 
patent lint, or cotton cloth, is moistened with aqua ammonia?, and 
when placed on the skin is covered with oiled silk to prevent evapora- 
tion. When the blister is raised the epidermis is removed with scissors. 
A less painful, but slower method, is the application of a cantharides- 
plaster, followed by a poultice to raise the blister. The medicinal agent, 
in a finely-powdered state, is sprinkled over the raw surface, and is 
rapidly absorbed. Morphia, atropia, strychnia, and quinia, are the most 
important agents used in this way. 

The endermic method is a useful resource to the therapeutist, but 
the opinion of Brown-Sequard is hardly admissible, that the extensive 
use of the hypodermic method has caused the endermic to be unwisely 
neglected. There are decided objections to the endermic method : it is 
painful; absorption is somewhat uncertain; ulceration of an intractable 
character may occur. It has these advantages in its favor : it may be 
used in cases of irritable stomach ; it may be conjoined with counter- 
irritation ; it is sometimes quite effective. 



II. 

THROUGH THE INTERNAL INTEGUMENT. 

Applications to the Broncho-pulmonary Mucous Membrane.— 
By the method of insufflation solid medicinal agents in a finely-divided 
state are applied to various parts of the respiratory tract. Insufflation- 
tubes with a rubber air-bag attached are now found at the instrument- 



NASAL DOUCHE. 5 

makers'. The powder, contained in a chamber intended for its recep- 
tion, is forced by the compression of the air-bag through the straight or 
curved delivery -tube of the instrument. Powders may be projected by 
such an apparatus into the fauces, larynx, and anterior and posterior 
nares. In the absence of an insufflator, a simple glass tube or goose- 
quill may be used for "the purpose — the powder being blown in by the 
operator, or drawn in by a forcible inspiration by the patient. 

The method of insufflation is a useful mode of making local appli- 
cations to the nares, fauces, epiglottis, and the aryteno-epiglottidean 
folds, but it is of little utility as a means of reaching the larynx and 
trachea, for, as is well known, the glottis is exceedingly intolerant of 
foreign bodies whether solid or gaseous. By this method we can use 
tannin, the zinc salts, nitrate of silver, alum, morphia, etc. Any remedy 
thus applied should be in small quantity, should be minutely subdivided 
and mixed with some unirritating, impalpable powder, so as to insure 
uniform distribution over the surface to be acted upon. 

The nasal douche is a mode of applying remedies to the nasal pas- 
sages now much practised. This consists of a bottle or funnel-shaped 
reservoir to contain the medicated fluid, and a flexible rubber tube to 
which is attached a hard-rubber or glass nose-piece. The reservoir be- 
ing placed on a higher level than the head, the nose-piece adjusted 
and the mouth being kept open, the fluid is permitted to flow. As when 
the mouth is open, the patient breathing quietly, the palate applies 
itself closely to the posterior wall of the pharynx, it is obvious that the 
fluid will be conducted from the one to the other nostril and thus make 
its exit. Not every patient can succeed perfectly in the performance 
of this feat. In some persons, even when breathing quietly through the 
open mouth, the veil of the palate does not apply itself perfectly to the 
posterior fauces and the fluid flows into the oesophagus. Other persons 
cannot refrain from attempts at swallowing when the fluid reaches the 
posterior nares. In such instances the use of the nasal douche may be 
attended with ill results. As has been shown by Moos, Roosa, and 
others, and as I have myself observed, the fluid may pass through the 
Eustachian tube into the middle ear, giving rise to destructive inflam- 
mation and suppuration. If pain in the ears follows its use, it is quite 
certain that mischief will result if the douche be persisted in. The fol- 
lowing rules should be adhered to in making applications by this 
method : 

The fluid used must be tepid. 

The first applications must be bland and unirritating. 

The applications, if strong enough to excite irritation, must not be 
used frequently. 

Under the most favorable circumstances this mode of treating dis- 
eases of the nasal passages has very limited utility, for the fluid readies 
but a part of the Schneiderian mucous membrane. It is a useful means 



3 HOW MEDICINES ARE INTRODUCED. 

of cleansing- the nares, and for applying deodorizing agents to correct 
fetor. Chlorides of sodium, potassium, and ammonium, permanganate 
of potassa, carbolic acid, iodine, and many other agents of the same 
kind, are applied by means of the nasal douche. 

An ordinary Davidson's syringe, made to act as a siphon, may be 
used in the same way as the Weber's or Thudichum's nasal douche. The 
mode of proceeding with this instrument is as follows : the vessel con- 
taining the medicated fluid is placed on a liigber level than the patient's 
head ; the syringe is filled by compressing the bulb to expel the air, 
and then inserting the suction-pipe in the fluid; the nozzle of the de- 
livery-pipe is put into the nose, when a steady stream will discharge 
into the nostril and escape by the other. 

The method of inhalation is more generally applicable to the treat- 
ment of diseases of the broncho-pulmonary mucous membrane. Iodine 
in vapor, iodoform, sal-ammoniac, bromine, and other volatilizable solids 
and gases, may be readily and advantageously applied in this way. A 
convenient mode of using iodine is the following : make a cone of stiff 
paper, so that the smaller extremity shall fit the mouth or nose, or 
both ; drop some tincture of iodine into a cup of hot water, so placed 
that the vapors will ascend through the funnel, the larger mouth of which 
is in position to intercept them. Iodoform vaporized on a warm plate 
or saucer may be similarly conducted into the mouth or nose. Some 
drops of bromine may be put into a warm vial, and the vapor be cau- 
tiously inhaled. Several forms of inhalers are now made for applying 
muriate of ammonia vapor, as it is formed by the combination of ammo- 
niacal gas and the fumes of hydrochloric acid. 

The above methods, although not without utility, are not equal in 
effectiveness to the method of pulverization or atomization of medi- 
cated fluids. Air or steam is the motive power in the various forms of 
apparatus used for reducing solutions of medicinal agents into spray. 
Of those now in use, the hand-ball apparatus for air, and Siegle's ap- 
paratus for steam, are the principal. Whether air or steam be used for 
pulverizing the medicated fluid, the essential parts of an atomizing 
apparatus consist of a cup fcr containing the solution to be pulverized, 
a vertical tube terminating in a fine capillary extremity and dipping 
into the medicine-cup, and a tube communicating with the steam-boiler 
or air-bulb, and placed at right angles to the vertical tube. When air 
or steam is forced through the horizontal tube, over the capillary ori- 
fice of the vertical tube, the air in the latter is rarefied and the fluid 
rises into it, until, reaching the top of the tube, it is broken up into fine 
spray by the impact of the horizontal column of air. It is obvious 
that, provided with suitable tubes, spray may be applied to the nares, 
anterior and posterior, to the pharynx, epiglottis, and larynx. The 
utility of applications made in this way to these parts is now conclusively 
established. Although it has been a question whether any quantity of 



BY THE GASTROINTESTINAL MUCOUS MEMBRANE. 7 

medicated spray passes the chink of the glottis, it has been proved 
experimentally that a minute quantity does actually enter the trachea. 
The efficacy of inhalations of subsulphate of iron in pulmonary hasmor- 
rhage is a clinical fact confirmatory of the experimental demonstrations. 
The inhalations of substances in a state of vapor, and atomized in 
affections of the parts beyond the larynx, have thus far been rather dis- 
appointing, except, it may be, the treatment of pulmonary haemorrhage 
by iron inhalations. 

In using the various inhalations, some precautions must be taken to 
avoid harm. Strong applications should not be made in the beginning 
of the treatment. The mucous membrane should be accustomed to the 
impact of such unirritating substances as warm water and tepid solu- 
tions of common salt and chloride of ammonium, before commencing 
the use of tannin, the zinc, copper, and silver salts, etc. For cleansing 
the mucous membrane and removing fetor, common salt, carbolic acid, 
iodine, and the sulphides are useful, and as astringents and deodorizers, 
the sulpho-carbolates of zinc, soda, etc. The most effective application 
for the cure of diseased states is nitrate of silver, but it should be kept 
in mind, in using this agent, that the handkerchiefs and linen of the 
patient will be soiled. Solutions of nitrate of silver are best applied 
by means of the hand-ball atomizer, tubes of various shapes, accord- 
ing to the locality, being inserted into the anterior and posterior nares, 
pharynx, or glottis, as the case may be. Should the steam atomizer 
be used for making application of the various salts named above, the 
face of the patient should be protected by a shield. 

Applications to the broncho-pulmonary mucous membrane are also 
made use of to procure absorption of the materials applied, and thus to 
produce systemic effects. Anodynes for the relief of cough, difficult 
breathing, painful affections of the heart, etc., are applied to the fauces 
and larynx by means of the steam atomizer. Various preparations of 
opium, cannabis Indica, belladonna, and nitrite of amyl, are employed 
in this way. The most effective method of treating an asthmatic par- 
oxysm is by means of a cigarette containing various narcotic substances. 

Applications to the Gasteo-Intestinal Mucous Memeeane. — 
The stomach is the organ most usually selected for procuring absorption 
of remedial agents. Diffusion through the walls of the stomach into 
the blood is by no means definite in rate, or in the quantity passed 
even with the same medicament and in the same individual. The 
presence of fluid or food, the chemical reactions which -may ensue, the 
6tate of the mucous membrane, the blood-pressure in the veins, and the 
condition of annexed organs, are circumstances modifying the rate and 
degree of absorption. The stomach empty, the mucous membrane in a 
healthy state, veins not turgid, are the conditions most favorable for 
rapid and perfect absorption. Crystalloidal substances in solution, 
which pass by simple osmosis into the vessels, are taken up more rap- 



3 HOW MEDICINES ARE INTRODUCED. 

idly and perfectly than colloidal substances, which require preliminary 
digestion and solution. It follows, therefore, that medicines in solu- 
tions not intended for a merely local action on the stomach mucous 
membrane, and not irritant in character, as salines, alkaloids, etc., 
should be administered when the stomach is empty. Substances that 
are irritant, or that require digestion and solution, or that, like iron, are 
intended to supply a material to the blood in which it is deficient, are 
best administered during the process of digestion. On the other hand* 
many of the metallic salts precipitate pepsin and thus derange digestion, 
whence it follows that they should not be given after food, if unim- 
paired digestion be essential to the safety of the patient. 

Although it is true that medicines in solution are more readily taken 
up than solids, yet many of the latter are absorbed with great facility, 
as metallic iron, calomel, etc., which are rendered soluble by the gastric 
fluids. The chemical changes induced in medicines by the gastric juice 
are by no means well understood. How individual agents are affected 
is a subject to be considered hereafter. 

The following are the chief forms in which medicines are adminis- 
tered by the stomach : 

Powders are medicines reduced by mechanical subdivision, or by 
precipitation, to the finest possible state. Those soluble in water are 
usually administered in that menstruum. If insoluble, they may be 
suspended in water by means of sugar, sirup, solution of gum, glyce- 
rine, or they may be rubbed up with some innocuous powder, as sugar, 
sugar of milk, liquorice-powder, etc. 

Pills are small masses of medicine made into a globular shape, by 
means of an extract, conserve of roses, sirup, or glycerine. A pill 
should not exceed five grains in weight, including the excipient, and, as 
a rule, it should be smaller than this. To cover the taste, pills may be 
coated with sugar, gelatine, silver, or gold foil. It should not be over- 
looked that pills too long kept, especially when sugar-coated, become 
very hard and insoluble, and therefore without activity. Extempora- 
neously, pills may be covered with fine tissue-paper, or enveloped in a 
raisin, to cover the taste of the ingredients. 

A mixture is a suspension of one or more insoluble substances in 
the vehicle, by means of sugar, gum, glycerine, treacle, albumen, etc. 
The term emulsion is restricted in application to the mixture of oil and 
water, in which the oily particles are suspended mechanically by rub- 
bing them up with water and gum. 

Extracts are solid and fluid. The solid extract may be aqueous 
or alcoholic ; in the one case water, in the other, alcohol, being the 
menstruum employed to extract the active and soluble principles. An 
extract is solid when evaporation is carried far enough to produce a soft 
paste or a dry mass ; it is fluid when sufficient alcohol and water are re- 
tained to give the proper fluidity. 



BY THE GASTROINTESTINAL MUCOUS MEMBRANE. Q 

Infusions are such solutions of active and soluble principles as can 
be extracted bj' digesting the crude drug in water, cold or at a tem- 
perature short of boiling. When water at the boiling temperature is 
used, the resulting solution is termed a decoction. Cold infusions 
are, as a rule, to be preferred to decoctions, for, at the tempera- 
ture of boiling water, many active principles are decomposed or 
volatilized. 

Wine, vinegar, and alcohol, are also used as menstrua. 

Cajjsides are hollow cylinders or cones of gelatine, to contain offen- 
sively-tasting substances, as copaiba, oil of sandal-wood, etc. In the 
stomach the gelatine is dissolved and the medicament liberated. 

Lozenges 'or Troches, button-shaped masses, are sometimes intro- 
duced into the stomach, but usually these bodies are intended to 
be dissolved slowly in the mouth, to exert a local action on the 
fauces. 

Wafers are circular disks with a central cavity for holding the medi- 
cine. They are made of isinglass. 

A Suppository is a conical mass of cacao-butter, or wax and cacao- 
butter, with which is incorporated a medicament. They are applied to 
the rectum, vagina, and urethra. 

Clyster, Enema, Lavement, are medicated solutions to be thrown 
into the rectum. 

Although the rectum as an absorbing surface is inferior to the stom- 
ach, medicines are frequently introduced by this organ with great ad- 
vantage. Some medicines enter the blood more quickly by the rectum 
than by the stomach, but, as a general rule, absorption is slower by the 
former organ. If the mucous membrane of the rectum be irritable, or 
if the substances introduced be irritating or bulky, they will not be re- 
tained. As the contents of the rectum are alkaline, solids requiring an 
acid for their solution will not be taken up. Acid solutions of medici- 
nal agents, on the other hand, are readily enough absorbed, provided 
the quantity of acid present be sufficient to maintain solution. As a 
general rule the mineral salts act chiefly locally on the mucous mem- 
brane of the rectum and enter the blood in small quantity. The salts 
of the alkaloids, on the other hand, are absorbed with facility. Alka- 
loids insoluble unless in presence of an acid are not absorbed with the 
same rapidity and completeness by the rectum as by the stomach, unless 
they are administered in acid solution. The salts of morphia, atropia, 
and strychnia, in solution, are absorbed as quickly, and the last named 
more quickly by the rectum than by the stomach. 

Remedies administered by the rectum may be in solution suspended 
in some menstruum, or incorporated with a soap or fat in the form of sup- 
pository. The solution used should have the temperature of the rectum 
(about 100° Fahr.). The quantity administered should not exceed two 
fluid-ounces of solution. Before introducing a medicated solution 01 



10 HOW MEDICINES ARE INTRODUCED. 

clyster into the rectum, this organ should be emptied of fecal matter 
by an ordinary enema. 

Administration of remedies by the rectum is an important resource 
to the therapeutist in cases of inability to swallow, irritable stomach, 
and in children's maladies. Unfortunately, this organ soon becomes 
intolerant, the mucous membrane irritable, and the medicament is either 
at once rejected or absorption delaj'ed. 

Applications to the Genito-Ukinary Mucous Membrane. — 
Brown-Sequard has proposed to utilize the bladder for securing absorp- 
tion of remedial agents in cases of great intestinal disorder, as in cholera. 
Experiment has shown that morphia, for example, is taken up with 
considerable rapidity by this viscus. 

Topical applications to the urethra and vagina are very frequently 
made, usually in the form of astringent injections. Suppositories, vari- 
ously medicated, are also occasionally used in the treatment of affections 
of these parts. 

in. 

BY THE SUBCUTANEOUS AREOLAR TISSUE— THE HYPODERMATIC OR 
HYPODERMIC METHOD. 

The term hypodermic is used in conformity with the nomenclature 
already existing — as " epidermic," " endermic," etc. As the term indi- 
cates, by this method the medicine is applied to the subcutaneous 
areolar tissue. This does not include the method of " inoculation," in- 
troduced by Lafargue, nor that proposed by Luton and Bertin, which 
consists in the injection of irritants into diseased tissues. It is obvious 
that by the hypodermatic method medicines can be introduced only in 
the state of solution. To introduce the solution under the skin, a spe- 
cial instrument is necessary. This is the now well-known hypodermic 
syringe — a small syringe having a capacity not to exceed a drachm 
— the nozzle being a hollow needle having a lancet-shaped extremity 
for easily transfixing the shin. These instruments are various in form 
and construction, and are made of gold, silver, glass, or hard rub- 
ber. The most efficient instrument for ordinary use is the silver hypo- 
dermic syringe described by the author. The piston-rod of this instru- 
ment should be semi-cylindrical and should be graduated for minims 
on its flat side, to indicate the quantity of solution contained in the 
barrel. Glass hypodermic syringes break easily, and the mountings 
work loose and give way. Now, however, the glass cylinder is in part 
inclosed in a metal sheath, for greater strength and security. A gradu- 
ated hypodermic syringe should not be used until the exact value of 
the divisions of the scale has been determined by comparison with a 
standard minim-glass. 



HYPODERMIC METHOD. U 

A medicine employed for hypodermatic use should be capable of 
perfect solution in the menstruum, which is usually distilled or pure 
water. Particles of medicine undissolved are not only not in a condition 
for ready absorption, but are irritant to the tissues, producing inflamma- 
tion and abscess. The solution for hypodermic use should be free from 
foreign matter of every description and should be neutral in reaction, 
or, at least, without decided acid or alkaline reaction. Any substance 
which will coagulate the blood or produce violent local irritation is un- 
fit for hypodermic use. A solution of even a neutral substance should 
not be too concentrated. Clean water, free from visible impurities, is 
entirely harmless, and the quantity of fluid injected is, within certain 
limits, a matter of indifference, provided suitable care be used in select- 
ing the site and injecting. On the other hand, concentrated solutions 
are more apt to produce local irritation than dilute solutions. More- 
over, a drop too much of a concentrated solution of a powerful alkaloid 
may produce an alarming, if not dangerous state. In ordinary syringes 
a few drops remain at the bottom of the barrel and in the needle — 
whence it follows, in using strong solutions, it is difficult to inject the 
precise amount desired. 

Solutions of alkaloids, too long kept, become unfit for use, hypoder- 
mically, by reason of the development in them of a penieillium, a 
minute organism which grows at the expense of the alkaloid. Fresh 
solutions should be made when needed. When hypodermic injections 
are used infrequently, it is preferable to prepare an extempore solution, 
using powders of a definite strength. Filtered river, melted ice, or 
rain water, may be used for dissolving the powders. Solutions prepared 
extemporaneously from ordinary spring or rain water are found to pro- 
duce less inflammation, and are less likely to be followed by abscess, 
than solutions prepared with pure distilled water which have been kept 
for several days. 

In practising the hypodermatic injection it is important to avoid 
puncturing a vein. Serious depression of the powers of life and sudden 
and profound narcotism have been produced by injecting a solution of 
morphia directly into a vein. Fatal collapse may ensue from injecting 
air into a vein along with the narcotic solution. Bony prominences 
ought to be avoided, and also inflamed parts. It is not necessary to 
follow Wood, the discoverer of the hypodermic method, who advised 
that the solution be inserted at those points where pain can be awa- 
kened by pressure (the painful points of Valleix). Some exceptions to 
this rule undoubtedly exist. The arm, the abdomen, the thighs, the 
calves of the legs, and the back, are suitable places. Eulenberg makes 
the assertion that the effect is slower when the injection is made in the 
back, but I have not observed this difference. 



12 HOW MEDICINES ARE INTRODUCED. 

IV. 

.BY THE VEINS. 

The injection into the veins of medicinal agents is too dangerous a 
procedure to be lightly undertaken, and is admissible only in emergen- 
cies. Formerly, before the introduction of the hypodermic method, the 
injection of medicines directly into the blood "was suggested and occa- 
sionally practised in cases of asphyxia, in the collapse of cholera, in the 
insensibility due to narcotic poisons, etc. At present this method is 
restricted within narrower limits. Some remarkable results have been 
obtained by the injection of a saline solution in the veins in cases of 
the collapse of cholera. Unfortunately, the appearances of improve- 
ment, which are very remarkable, are not usually sustained, although 
Little reports five recoveries out of twenty apparently hopeless cases 
treated in this way. Dr. Hilton Fagge has recently reported a case of 
diabetic coma, in which the injection of twenty-six ounces of a warm 
solution of salines (phosphate and chloride of soda) produced an aston- 
ishing improvement in the condition of the patient. A suitable saline 
solution for intra-venous injection may be made of phosphate, carbonate, 
and chloride of sodium, dissolved in water at the temperature of 100° 
Fahr. until the specific gravity of 1020 is attained. The instruments 
employed for transfusion of blood may be used for the intra-venous in- 
jection of salines, especially the apparatus of Dr. Aveling for immedi- 
ate transfusion, or the aspirateur modified according to the plan of Dr. 
Howe, of New York, when used for transfusion mediate or immediate. 
In the absence of these, an ordinary Davidson's syringe may be used 
for this purpose by attaching to it suitable canulae. 

Halford, of Australia, has recently practised the injection of am- 
monia into the veins, in the treatment of the bite of venomous snakes. 
He employs one part of the stronger aqua ammonia} to two parts of 
distilled water, the injection being made with an ordinary hypodermic 
syringe. A vein in a convenient situation is selected, the needle is in- 
serted into it, and the solution of ammonia is thrown in gradually. The 
operation may be repeated as necessar}-, the guide to the repetition of 
the injection being the state of the circulation. Fayrer shows that this 
practice is not successful in the systemic condition caused by the bite 
of the venomous snakes of India, and the special committee of the 
Medical Society of Victoria, appointed to investigate the subject of 
the intra-venous injection of ammonia, report adversely to the claims 
of Halford. The proposer of this expedient has, at least, demon- 
strated the safety of the intra-venous injection of ammonia ; and, 
although his first claim has been shown to be incorrect, the method 
itself has been utilized in other maladies : for example, in choloroform 



TRANSFUSION. 13 

asphyxia, opium narcosis, hydrocyanic-acid poisoning, etc. It has 
been used, not with encouraging success, however, in septic states with 
a tendency to the coagulation of the blood in the larger venous trunks. 
Failure of the heart's action and thrombosis of the pulmonary artery, 
post par turn, are also indications for the intra-venous injection of am- 
monia. 

Transfusion. — This consists in an operation for substituting health}' 
blood for the abnormal fluid occurring in certain diseases, and for sup- 
plying blood in cases in which a deficiency exists by reason of haemor- 
rhage. Ordinarily the blood of a healthy adult is used in transfu- 
sion, because ever since the time of Blundell it was supposed the blood 
of an animal would not functionate properly in the arterial system. 
This notion is now, however, fully exploded, and Gesellius has es- 
pecially shown, in his elaborate monograph on transfusion, that lamb's 
blood will answer the same purpose in the human system as human 
blood. 

As the red globule is the vivifying constituent of the blood, and as 
the fibrin is non-essential to the most important office, at least, of the 
circulating fluid, it is obvious that defibrinated blood may be used for 
transfusion. According to the statistics collected by Gesellius, of one 
hundred and forty-six cases of transfusion with blood without defibrina- 
tion, seventy-nine, or 54.11 per cent., were successful, and, of one hundred 
and fifteen cases in which defibrinated blood was used, seventy-nine, or 
68.70 per cent., proved fatal. Mr. Higginson, of Liverpool, reports 
thirteen cases occurring under his own observation, in which mediate 
transfusion with pure blood was employed, with the result of six suc- 
cessful. The injection of defibrinated blood is free from one source of 
danger — the introduction of clots into the circulation — which, as Panum 
has shown, will be followed by the disastrous result of multiple embo- 
lisms, or thrombus of the pulmonary artery. Separating the fibrin, how- 
ever, renders the blood much less capable of performing its office. The 
necessary agitation in order to coagulate the fibrin injures the blocd- 
globules, and the fibrin itself is necessary to prevent transudations and 
the recurrence of haemorrhage. With the improved instruments now 
used for the operation, and with the exercise of the necessary care, 
there need be no formation of clots, the chief danger in the use of blood 
containing its fibrin. 

Transfusion may be mediate or immediate. Mediate transfusion 
consists in the reception of the blood in a suitable vessel, and its trans- 
ference by means of an injecting apparatus into the veins of the patient. 
Immediate transfusion consists in an apparatus for making direct com- 
munication, from the vein of the person or animal furnishing the blood, 
with the vein of the patient receiving it. A number of appliances have 
been invented for mediate transfusion. Martin, of Berlin, has used in 
his operations a glass sj'ringe provided with a suitable canula for inser- 



14 HOW MEDICINES ARE INTRODUCED. 

tion into the vein. Belina invented an apparatus consisting of a re* 
ceiver for the blood, a hand-ball like that of the spray-douche, and a 
flexible tube provided with a stop-cock and canula. Belina, who has 
treated at great length of the operative procedure, decides that all forms 
of syringes are objectionable. Higginson proposed and has used suc- 
cessfully an instrument similar to the enema-syringe invented by him. 
This apparatus can, however, only be used for mediate transfusion. As 
immediate transfusion is to be preferred, as a rule, it were better to be 
provided with a suitable instrument for this operation. The instrument 
invented by Dr. Aveling, and presented to the Obstetrical Society of 
London in 1864, is at the same time the simplest and most effective. 
This consists of a hand-ball and flexible tubes like a Davidson syringe, 
but without valves. There are two canulse attached to either extremity 
of the flexible tubes — one for insertion into the vein furnishing the 
blood, and the other for insertion into the vein receiving it. The small 
size Davidson syringe will answer perfectly well by removing the valves, 
the action of which tends to separate the fibrin, and fitting to the flex- 
ible tubes suitable perforated needles or canulse. In using Aveling's 
instrument it must be first put into water at the temperature of 100° 
Fahr., and it must be filled with warm water, or better, a warm solution 
of phosphate and chloride of sodium of a specific gravity of 1020. The 
object of this is to exclude the air from the apparatus. The next step 
consists in inserting the canula in a vein — usually of the forearm — of the 
person or animal furnishing the blood, and in a position so that the 
blood-current will be in the direction of the current in the patient re- 
ceiving it. Should the veins of the patient be collapsed, the skin over- 
lying those at the elbow may be transfixed and raised, which will bring 
into view a vein into which the canula may be inserted — care being 
used here that the direction of the current shall be toward the heart. 
The canulse can be held in position by the fingers of assistants. The 
operator compresses the bulb gently, pressing at the same time the sup- 
ply-tube between the thumb and finger of the other hand, in order to 
prevent a reflux of the fluid. When the bulb is emptied, the delivery- 
tube is pressed between the thumb and finger shifted from the supply- 
tube, and the bulb is allowed to fill with blood from the source of sup- 
ply. In this way, successive charges of fresh blood can be delivered 
without difficulty into the patient's vein. The aspirateur may be used 
in the same way for immediate transfusion, as has been suggested by 
Dr. J. W. Howe, of New York, who has used it successfully. He ad- 
vises the substitution of smaller tubes than those which accompany this 
instrument, and he has devised suitable canulse for the veins. 

The quantity of blood, which it is advisable to introduce, varies from 
four to eight ounces. The smaller amount is generally more successful. 
Too large amount will seriously embarrass the heart. A further precau- 
tion is necessary as to the manner of injection ; force is never necessary 



TRANSFUSION. 15 

and may be very injurious ; the blood should be delivered into the vein 
slowly and gently. 

Besides the danger arising from coagulation of the blood and the 
formation of thrombi, immediate bad symptoms or fatal syncope may 
come on from the introduction of air into the veins. The utmost care is 
necessary to exclude air from the apparatus. Phlebitis may also ensue 
from the injury done to the vein, and the patient's life put in jeopardy 
from this cause, but this is a danger much more remote than the intro- 
duction of air and clots into the circulation. 

As a number of successful cases of transfusion (Gesellius, Hasse, 
and others) have been reported in which lamb's blood was used, the 
practitioner is now justified in its employment, notwithstanding Landois 
has shown by experiment that transfusion of mixed blood does injury to 
the red blood-globules. If lamb's blood is to be used, the animal should 
be sufficiently anaesthetized to keep it quiet, and it should be securely 
tied. A vein may be selected, and immediate transfusion performed 
with Aveling's instrument or with the aspirateur in the mode already 
described. 

Transfusion is especially indicated in cases in -which life is put in 
imminent jeopardy by haemorrhage. According to Belina, it is in haem- 
orrhage from abortion, and during the first months of pregnancy, that 
transfusion is most successful. Of thirteen cases of haemorrhage from 
abortion thus treated, according to this author, eleven had a fortunate 
issue. Of the cases of post-partum hemorrhage-weighty -&ve in num- 
ber — in which this expedient was adopted, fifty-six resulted favorably. 
Routh, Soden, Hicks, McDonnell, Mudge, Howe, and others, have re- 
ported successful cases, not included in the statistics of Belina. In 
other forms of haemorrhage, hematemesis, intestinal hemorrhage, epis- 
taxis, etc., in which death by exhaustion is imminent, the operation of 
transfusion is proper. Belina has collected twenty-six cases of trau- 
matic haemorrhage, of which twelve resulted favorably, in two the re- 
sult was doubtful, and twelve terminated fatally. 

Transfusion has also been employed in certain morbid states of the 
blood, but not with encouraging results. Thus, Belina has collected a 
number of cases belonging to this category, of -which nineteen terminated 
favorably, in two the result was equivocal, in three temporarily benefi- 
cial, and thirty -nine died. ^Two very interesting cases of the hemor- 
rhagic diathesis successfully treated by transfusion have been reported 
by Dr. Joseph Buchser, of New York. This form of constitutional 
cachexia is especially an indication for transfusion. In the treatment 
of anemia this operation has not been successful. Thus, three cases 
treated by Stohr, of Wtirzburg, terminated fatally. Cases have also been 
reported by Concato, Cavaleri, and others. Transfusion has been used 
very successfully in cases of carbonic-oxide poisoning (Uterhart, Prof. 
Konig, Prof. Martin), and in phosphorus-poisoning (Prof. Jlirgensen.) 



16 HOW MEDICINES ARE INTRODUCED. 

Eulenburg and Landois advise transfusion in cases of danger to life 
from poisons for which there are no antidotes. It has been recommended, 
in such cases, to abstract blood and to supply fresh blood to the suffer- 
ing organism. Nussbaum has employed transfusion with complete 
success in epilepsy, and it has also been used with favorable results in 
eclampsia due to tirmmic poisoning. 

, Arterial Transfusion. — Prof. Albanese has proposed injection of 
defibrinated blood into an artery, either the radial or posterior tibial, as 
a substitute for the intra-venous injection. The artery is exposed, punct- 
ured, and the blood thrown into it, in the same way as in the operation 
on the vein. It is claimed for this method that thrombosis is less apt to 
occur, and that the danger arising from the introduction of air is obvi- 
ated. When a large amount of blood is necessary, it is more safely 
introduced by the arterial system, because, having to traverse the capil- 
laries before reaching the right side of the heart, sudden distention of 
this organ is avoided. Prof. Hitter, who has especially advocated this 
method, reports a number of cases successfully performed in this way, 
and Asche has collected a number of others. 

Transfusion of Milk. — The experiments of Donne on animals demon- 
strated the harmlessness of the intra-venous injection of milk. Hodder, 
of Canada, was the first to employ this expedient on man ; and, of three 
cases of cholera collapse which he thus treated, two recovered. Thomas, 
of New York, has also transfused milk with success in postpartum 
haimorrhage ; and Wagstaff has failed twice with the same method in 
traumatic haimorrhage. "Within the present year (1880) Mr. Arthur 
Meldon has published an account of three cases in which the transfu- 
sion of milk was performed with success (Lancet). 

When milk is used for transfusion, it should be fresh and directly 
from the cow if practicable, and its temperature should be that of the 
blood itself — 100° F. Not more than four to six ounces should be 
injected at one time, lest the heart be paralyzed by over-distention. 
The effects which follow the intra-venous injection of milk are very 
much the same as those produced by blood, except that they are prob- 
ably less permanent, and that albuminuria is a frequent result. That 
this expedient is as useful as blood transfusion by the immediate 
method has been strongly maintained, but the most recent experience 
does not justify this opinion. Indeed, it is probable that the chief 
value of blood transfusion, in functional diseases, is to gain time for 
the operation of other and more permanent measures (Pepper). We 
also agree in the estimate of Dr. Pepper that transfusion in any of its 
forms is without utility in important organic diseases. 

In an experimental inquiry into the methods of transfusion, 
Schafer has examined anew the question of the substitution of some 
other fluid for blood, deciding with Landois, of Germany, and Howe 
and Dupuy, of America, that the introduction of any other fluid does 



TRANSFUSION. 17 

injury to the corpuscles, and that a fluid without hamioglobin cannot 
functionate as blood. As respects the substitution of the blood of 
some other animal — lamb's blood, for example — the conclusion of 
Schafpr is in accord -with the previously expressed judgment of Lan- 
dois, that only human blood should be used in transfusion on man. 
Schafer has, also, made some important observations on the best mode 
of performing the operation. He finds that the best results are ob- 
tained on animals by arterial transfusion, and recommends that the 
dorsal artery of the foot be used for receiving and furnishing the 
blood in the operation on man. When the artery is used the blood is 
received into that part of the vascular system where it is most needed, 
and only an elastic rubber tube and glass canula are required, the force 
of the donor's circulation being sufficient to propel the blood. There 
is no danger of the supply from the donor becoming excessive, as the 
pressure in the arterial systems of the donor and of the recipient soon 
acquires the same force. Usually, and indeed unless the circulation 
in the donor is feeble, no other medium of communication is necessary 
besides the flexible tube and glass canula, as the elastic pump of Ave- 
ling's instrument does not contribute to the force of the flow. The 
tube and canulse should be filled with carbonate-of-soda solution, both 
to exclude air and to prevent clots forming. It is not necessary to 
measure the quantity of blood, as the condition of the recipient fur- 
nishes the true indications to be followed. 

Peritoneal Transfusion. — To the various kinds of transfusion 
must now be added this form, originally proposed by Ponfiek. "With 
antiseptic precautions, a trocar with canula is passed through the ab- 
dominal walls in the linea alba. A flexible tube, with a glass funnel 
attached, is then connected with the canula — the trocar being with- 
drawn — and defibrinated blood is poured into the cavity. Excellent 
results follow this practice, which the researches of Bizzozero and 
Golgi have shown to be based on sound physiology. This method has 
been used successfully by Von Kaczorowski and others in the various 
maladies in which the other modes of transfusion have been em- 
ployed. 

Authorities referred to : 

Albanese. Berliner Minische Wochenschrift, 1870, p. 470. 

Asche. Die ncuern Mittheilungen iiber Transfusion des Blutes, Schmidt's Jahrbiichcr 
der gesammtcn Mcdicin, vol. cl., p. 329. 

Avelixg, Dr. J. H. Lancet, vol. ii., 1872, p. 147. 

Belina. Archives de Physiologic, Normals et Pathologiquc, 1870, p. 43, ct scq. 

Bennet, J. Hughes. T7te Practitioner, yol. i., p. 211. 

Brown-Seqcard. Lectures on the Diagnosis and Treatment of Functional Nervous 
Affections, part i., Philadelphia, 1868. 

Bcchser. The Medical Record, October 1, 1S69, p. 337. 

Erlesmeyeu. Die subcutanen Injectionen der Arzneimittel, dritte Aufiage, NeuwicJ ; 
1866. 

3 



18 HOW MEDICINES ARE INTRODUCED. 

Eulenburg. Die hypodcrmaiische Injcctioncn dcr Arzneimittel, zweitc Auflage, Berlin, 
1867. 

Eulenburg tjnd Landois. Ucber dcs Transfusion des Mutes, as quoted by Belina. 

Fagge. Guy's Hospital Reports, vol. xix., 1874, p. 173. 

Gesellius. Die Transfusion des Blutes, cine hislorische, kritische und physiologische 
Studie, St. Petersburg, 1873. 

Hal-ford. Medical Times and Gazette, vol. x., 1870, pp. 83, 278. 

Hicks. Guy's Hospital Reports, 1869, p. 1. 

Higginson. Liverpool Medical and Surgical Reports, vol. v., p. 104. 

Huter. Berliner kliniscke Wbchenschri/t, 1870, p. 470. 

Jurgensen. Berliner kliniscke Wochenschrift, 1871, No. 21. 

Little. The Medical Times and Gazette, London, 1867, p. 354. 

Landois. Berliner Centralblatt. Abstracted in Schmidt's Jahrbucher. 

McDonnell. Dublin Quarterly Journal, May, 1870. 

Pantm. Experimentelle Untersuchungcn ueber Transfusion, Transplantation oder Sub- 
stitution des Blutes, Virchow's Archiv, xxvii., p. 249. 

Pepper, Prof. William, M. D. Paper read before the Medical Society of the State of 
Pennsylvania. 

Routh. Tlie Medical Times, 1849, p. 144. 

Schafer, E. A. The Lancet, December 13, 1879, p. 876. 

Soden. Medico-Chirurgical Transactions, vol. xxxv., p. 143. 

Von Kaczorowski, Dr. Wiener medicinische Wochenschrift, 1880, No. 46. 

Waller. TJie Practitioner, London, vol. -in., p. 329. 



PAET IT. 
THE A CTIONS AND USES OF REMEDIAL A GENTS. 



THOSE USED TO PROMOTE CONSTRUCTIVE 
METAMORPHOSIS. 

ALIMENTS. 

This extensive subject can, in this work, be considered briefly only, 
and from the point of view of therapeutics. The various aliments are 
of the first importance as remedial agents. No satisfactory repair of 
diseased or wasting tissues can take place without a suitable supply 
of healthy blood, and healthy blood is the product of proper food and 
normal digestion and assimilation. 

The Physiological Relations of Food. — The food of man is 
derived from the three great kingdoms of nature : mineral, vegetable, 
animal. It may be conveniently classified into three great groups : 
1. Mineral constituents — incombustible or unoxidizable — water, phos- 
phate of lime, chloride of sodium, etc. ; 2. Oxidizable — heat-produc- 
ing and force-forming — carbon compounds — fat, sugar, starch, gum, 
etc. Nitrogenous — flesh-forming, albumen, fibrine, caseine, etc. ; 3. 
Food adjuncts — alcohol, acids (citric, tartaric, etc.), alkaloids, caffeine, 
theine, etc. 

The members of the first group will be discussed hereafter, under 
the head of " agents promoting constructive metamorphosis ; " the 
second group, the most important, will be considered in this relation, 
with the foods ; and the third will have separate treatment under ap- 
propriate heads. 

The classification of foods, originally formulated by Liebig, if not 
too strictly adhered to, is of much utility, as indicating the general 
purposes of these substances in the economy — viz. : carbonaceous or 
force-producers ; nitrogenous or flesh-formers. Under the first di- 
vision are comprehended fat, starch, sugar, etc. ; under the second, 
substances containing nitrogen, as albumen, casein, etc. There is not, 
however, a rigid line of separation between these two classes, for both 



20 RESTORATIVE AGENTS. 

are more or less concerned in the functions attributed to each, but 
their most important position and office are as assigned by the classifi- 
cation. 

The ultimate uses of food are two : to construct tissues or repair 
them when destroyed by wear ; to supply force — muscular, nervous, 
secretory, etc. The reception, digestion, and absorption of food is 
known as the primary assimilation ; the utilization of the material 
for the growth and repair of the tissues, and by the organs, as force, 
constitutes the secondary assimilation. 

The first step in the primary assimilation is the mechanical subdi- 
vision of the food by mastication. The admixture of the saliva with 
the food facilitates the process of mastication, and, as it contains a fer- 
ment, ptyalin, which has the property of converting starch into sugar, 
a portion of this constituent undergoes conversion ; but, probably, the 
chief use of the saliva is to give a slight alkaline reaction to the mass 
of food. According to the laws of osmosis, the entrance of an alka- 
line fluid into the stomach hastens the formation of the acid gastric 
juice. In the stomach, under the influence of the ferment, pepsin, and 
the acid (hydrochloric) of the gastric juice, the nitrogenous materials 
— the albuminous constituents of the food, the proteids — are trans- 
formed into peptones. Although fat is necessary to the stomach di- 
gestion, it does not undergo conversion in the stomach, and escapes 
in a coarse emulsion, with the chyme, into the duodenum. Starch, 
sugar, and gum, also pass into the chyme unchanged, although sepa- 
rated from their proteid envelopes, by the action of the gastric juice, 
except such portions as may diffuse directly into the stomach-veins. 
The peptones, to a large extent, diffuse into the blood from the 
stomach, and doubtless, also, such crystalloiclal substances as sugar, to 
some extent. The chyme contains parapeptones, starch, fat, sugar, 
and refuse matter remaining undissolved. In the duodenum the acid 
chyme mixes with the alkaline intestinal and pancreatic juices and 
the bile, which are poured out freely as the materials from the stomach 
distend the canal. Here the conversion of starch into sugar takes 
place actively, and the fats are emulsionized, and to some extent, also, 
saponified. The pancreatic juice not only emulsionizes the fats, but 
separates them into their component fat acids and glycerine, and the 
acids meeting alkaline bases form soaps, which are readily diffusible. 
The action of the bile is also very important. It renders the soaps 
formed soluble, and promotes the emulsionizing of the fats. Its agency 
in the digestion of the fats is well shown in the results of the experi- 
ment for forming a biliary fistula. When the bile is conveyed exter- 
nally, the amount of fat entering the lacteals is much below normal, 
and instead, the fat appears in the stools. In the small intestine the 
proteids which escape conversion in the stomach are transformed, un- 
der the agency of the bile, pancreatic fluid, and intestinal juice, into 



ALIMENTS— ANIMAL. 21 

peptones and other substances, the starch is converted into sugar, and 
the fats are emulsionized, and in part, also, saponified. These nutri- 
tion materials diffuse into the portal veins and into the lacteals, so 
that, by the time the intestinal contents reach the ileo-csecal valve, 
they are composed, for the most part, of excrementitious matters and 
the refuse of the foods taken. 

When the nutrition of the body goes on in the normal manner, 
there exists a certain ratio between the income and the outcome. The 
income consists of the proteids, fats, carbo-hydrates, salts and water 
of the food, together with the oxygen absorbed from the atmosphere. 
The outcome is made up of the excreta of the respiratory act, consist- 
ing of carbonic acid and water with a little hydrogen ; of the perspi- 
ration, composed of water and salts ; of the urine, which contains the 
nitrogen excreted from the body and a large quantity of saline mat- 
ter ; and of the faeces, composed of excreta from the immense glandu- 
lar apparatus of the ilium and colon, and from the liver. In a per- 
fectly healthy condition of the body, after it has attained its full 
growth, there should be an exact ratio between the income and out- 
come ; the income should suffice to furnish the force necessary for the 
performance of the various functions and to repair the waste of the 
outcome. In an ideal dietary, the amount of the food should be suffi- 
cient to maintain this ratio at the- normal standard. 

As respects classification of foods, for the purposes of this work, 
they may be considered under the natural divisions of Animal and 
Vegetable. 

Animal. — One of the most important articles of diet for the sick is 
Beef, and it should be of good quality : the bone should not exceed 20 
per cent. ; the fat should be firm, not yellow, and free from blood, and 
should not be in too great proportion relatively ; the muscle should be 
firm without being tough, not too pale, nor dark colored, and should not 
present any marbling or lividity on cross-section. The most esteemed 
parts of the beef are the thigh and hip (round, sirloin, fillet), the loin 
and certain parts of the shoulder (rib roast, porter-house steak, etc.). 
The composition of beef, according to* Moleschott's mean of the Con- 
tinental analyses, is as follows (Parkes) : 

Water 73.4 

Soluble albumen and hsematin 2.25 

Insoluble albuminous substances 15.2 

Gelatinous substances 3.3 

Fat 2.87 

Extractive matters 1.38 

Creatine '. 0.068 

Ash 1.6 

The ash contains chlorides of sodium and potassium, potash, soda, lime, 
magnesia, iron (oxide or phosphate), phosphoric acid, sulphuric, chlorine. 



22 RESTORATIVE AGENTS. 

and silica. The composition of cooked meat, according to Moleschott 
(Parkes), is as follows : 

Water 64. 

Albuminates 27.6 

Fats : 15.45 

Salts 2.95 

It will be perceived from the foregoing analyses that beef contains ali- 
mentary principles the most important for the nutrition of the body. 
When of good quality, neither too old nor too young, the fat and mus- 
cle suitably proportioned, and not altered by disease, and properly 
cooked, it is the best of the animal foods. 

Veal is less digestible and less nutritious than beef, and has a laxa- 
tive action, which may, however, be utilized in states of disease. It 
is more albuminous than fibrinous and abounds in gelatine (Fonssa- 
grives). The thymus gland of the veal (sweetbread) is, when "plainly 
cooked (by boiling) and moderately seasoned, a very agreeable and suit- 
able dish for the convalescent." — (Pereira.) 

Mutton, although possessing a lower degree of nutritive value than 
beef, is one of the most useful of the animal foods, as it is easily digested. 
Many patients, however, experience a marked degree of repugnance to 
mutton and cannot be induced to make use of any article of diet contain- 
ing it. An evident idiosyncrasy exists in some constitutions against it, 
so that taken disguised in any way it disagrees with the stomach. It 
does not continue long in favor as the exclusive article of the meat por- 
tion of the diet, even with those who relish it for occasional use. 

Pork contains more fatty matter and more often disagrees than the 
meats above described. Many dyspeptics cannot make use of it in any 
form : on the other hand, breakfast bacon may be much relished and be 
easily borne. Pork is rarely prescribed as a diet for tbe sick, but, for 
convalescents, roasted sucking pig, which is easily digested, may be 
ordered to vary the food and to stimulate a languid appetite. 

Venison is more easily and quickly digested than beef, but does not 
possess the same nutritive value. It is useful as an occasional article 
of diet for the state of convalescence and during a course of special 
animal diet, but for habitual consumption is not equal to beef. 

The domestic Chicken is a most important article of food for sick and 
convalescents. The taste is agreeable, the tissues soft and easy of 
mastication and digestion. " Spring chickens " are more tender and deli- 
cate than the fully-developed fowl of four or six months. Next to the 
chicken in ' point of digestibility is the domestic turkey, and after this 
the domestic goose and duck. Certain " game birds," e. g., the prairie- 
chicken, wild-ducks, woodcock, snipe, are frequently prescribed for con- 
valescents, and possess a high degree of nutritive value, but are not, 
of course, adapted for habitual use. 



ALIMENTS— ANIMAL. 



23 



The viscera of certain animals are sometimes employed as food. 
Allusion has already been made to " sweetbreads," the thymus of the 
calf. The brain, tongue, heart, liver, kidneys, and alimentar}' canal, are 
occasionally eaten, but are not frequently prescribed for the sick. 
Brain is easily digested, and, as it contains fats in combination with 
phosphorus, may be usefully prescribed in conditions of disease in 
which these constituents are presumed to be deficient in amount. 
Liver, as ordinarily prepared by frying, is very trying to weak stomachs, 
but this food contains matters which may be utilized in certain diseased 
states. According to Braconnot (Pereira), the composition of liver is 
as follows : 

Brown oil, containing phosphorus 3.89 

Nitrogenous matter 6.07 

Albumen 20.19 

Salts 1.21 

Water 68.64 

Kidneys, especially as ordinarily prepared, are very difficult of 
digestion, and are unsuited for the sick. As they contain a notable 
quantity of urea and other excrementitious matters, they are for this 
reason objectionable articles of diet. Tripe, the stomach of ruminants, 
is very easily digested and very nutritious, when prepared in the simple 
way, only, which is advisable for invalids. It consists largely of albu- 
men. 

In order to test the relative value of the animal foods considered in 
the foregoing pages, Marchal de Calvi (Fonssagrives) made a series of 
elaborate examinations to determine the proportion of water and fat to 
the solid. The results were as follows : 



Fibbt Analysis. 



Second Analysis. 



ANIMAL FOODS. 


Solid Matters. 


Water. 


Solid Matters. 


Water. 


Pork 


294.50 
277.00 
265.50 
263.50 
260.00 


705.50 
723.00 
734.50 
736.50 
740.00 


302.50 
275.00 
263.50 
263.00 
255.50 


697.50 


Beef. 


725.00 




736.50 




737.00 


Veal 


744.50 



These analyses assign to pork the first position. In another series 
of experiments M. Marchal used ether to dissolve the fat contained in 
the fibres of these meats. His results are expressed in the following 
figures : 





ANIMAL FOODS. 


Matters soluble in Kther. 


Matters Insoluble In Ether. 


Beef. 


25.437 
14.070 
59.743 
29.643 
28.743 


249.563 




248.930 


Pork 


242.757 




233.857 


Veal 


226.757 



24 RESTORATIVE AGENTS. 

According to these experiments, from the chemical point of view, 
beef has the highest nutritive value, chicken ranks second, and is but 
little inferior to beef, while veal is the lowest. 

There are certain substances of animal origin which possess great 
importance as dietetic agents, viz., eggs, and milk and its products. 

Eggs. — The following observations refer to the eggs of the domes- 
tic chicken. The egg is composed of four distinct parts : the shell ; 
the membranous envelope of the albumen ; the white ; the vitellus, or 
the yellow. The envelope of the albumen contains nitrogen and sul- 
phur, and phosphate of lime remains after incineration. The white or 
the albumen contains in 100 parts : 

Albumen 12 to 15 

Matter not coagulable 5 

Water 80 

The residue after incineration of the albumen is composed of phos- 
phates and sulphates of lime and magnesia, and alkaline carbonates. 
The yellow is a phosphorated fatty matter suspended in water by 
means of an albuminous substance known as vitelline. The yellow 
contains 53.78 parts of water, 17.47 of albumen, and 28.75 of fatty 
matter. According to Gobley (Fonssagrives, from whom most of these 
details have been obtained), the yellow has the following chemical con- 
stitution : 

"Water 51.486 

Vitelline 15.760 

Margarine and oleine 21.304 

Cholesterine 0.438 

Margaric and oleic acids 7.226 

Phospho-glyceric acids 1.200 

Sal-ammoniac. . . .'. 0.034 

Salts 7.299 

Extracts ' 0.400 

Ammonia, nitrogenized matters, coloring matter, lactic acid. . . 0.833 

Eggs consumed by the sick should be fresh and sound. The average 
weight is about two ounces avoirdupois. According to Parkes, the fol- 
lowing are tests of the freshness and soundness of eggs : 

"Fresh eggs are more transparent in the centre; old ones at the 
top. Dissolve one ounce of salt in ten ounces of water: good eggs 
sink, indifferent swim. Bad eggs will float even in pure water." 
Fonssagrives recommends the same tests. Eggs coated with beeswax 
dissolved in warm olive-oil (one-third beeswax two-thirds olive-oil) it 
is said may be preserved for two years. 

Eggs raw, or better, whipped, are the most digestible of alimentary 
substances, and, as their composition indicates, possess a very high de- 
gree of nutritive value. 



ALIMENTS— ANIMAL. 25 

Jlilk is one of the most important articles of food for the sick, and 
enters largely into the composition of various diets. It is constituted 
essentially of four elements — albuminoid, fatty, saccharine, and saline — 
and therefore contains all the materials necessary for the growth and 
nutrition of tissues. The nitrogenous constituent is caseine, an albu- 
minoid substance, but which differs from ordinary albumen in that it is 
combined with a larger proportion of alkali, and is not coagulable by 
heat. The fatty element is butter, which contains several neutral fats. 
The composition of butter is not exactly the same in all kinds of milk 
the difference being due chiefly to a volatile principle upon which the 
special taste of each variety depends. The saccharine element is a crys- 
tallizable sugar, known as lactine or lactose, a substance which easily 
decomposes into lactic acid by a process of fermentation in which the 
caseine plays the part of a ferment. The mineral constituents of milk 
are, chlorides of sodium and potassium, phosphates of lime, soda, mag- 
nesia and iron. The most important of these is the phosphate of lime. 
The amount of these salts varies from .5 to .8, and rarely exceeds one 
per cent. (Parkes). The French commission, appointed by the Prefect 
of Police of Paris, reported upon the analyses of milk made in various 
countries, and concluded that the following figures represent the com- 
position of this fluid when of good quality (Tardieu) : 

Water 87 

Total solids 13 

CaMine, Extractive 

Matters, and Salts. Butter. Lactone. 

Solids 4.00 4.00 5 

The commission fixed the minimum standard of good milk at — 

Water 88.50 

( Caseine, extractives, and salts 4.00 

Solids 11. 50-j Butter 2."70 to 8.00 

( Lactine 4.50 

When perfectly fresh, milk is usually neutral in reaction, or it may 
be a little alkaline. After a short time — especially in summer — it be- 
comes acid by a process of fermentation in which the lactine is con- 
verted into lactic acid, and the caseine coagulates. The fluid portion 
is called whey, and the semi-solid caseine curds. Hy the fermentation 
of mare's-milk an alcoholic liquor, named koumiss, is prepared in Tar- 
tar v, and has been introduced into medical practice as a remedy for 
phthisis. 

The proportion of cream in good milk ranges from 10 to 15 per 
cent, by volume. By churning, the fat of the cream is collected and is 
then known as butter. This important article of food has the following 
composition (Fonssagrives) : 



26 



RESTORATIVE AGENTS. 



Margarine 68 

Butyroliue SO 

Butyrine, caprine, and caproine 2 

Butter readily undergoes decomposition — becomes rancid — capric 
and butyric acids separating from tbe base glycerine. This process is 
one of fermentation, and is favored by air, light, and imperfect separa- 
tion of milk in the process of churning. Rancid butter, it need hardly 
be observed, is not suitable for food. 

After the process of churning, which separates the butter, the re- 
sultant liquid, known as buttermilk, contains the caseine, lactine, and 
the salts, and is therefore a nutritious article of food. 

As the milk of other animals than the cow is sometimes prescribed 
in medical practice, the comparative chemical constitution of this fluid 
should be studied. The following table (Pereira) shows at a glance 
the difference in composition of the milk from several animals : 



CONSTITUENTS. 


Cow. 


Ads. 


Goat. 


Woman. 




4.48 
3.13 

4.77 

0.60 

87.02 


1.82 
0.11 
6.08 
0.34 
91.65 


4.02 
3.32 
5.28 
0.58 
86.80 


1.52 




3.55 
6.50 


Salts 


0.45 




87.98 







Whenever fresh and pure milk can be procured, this only should be 
prescribed for the sick, but in large cities it is not always practicable to 
obtain it. Under these circumstances " condensed milk " must be used. 
This preparation is made by evaporation of the water of the milk and 
the addition of some sugar. It is found in two forms, dependent on the 
extent to which the abstraction of water is carried : as a granular solid 
and as a soft semi-solid. The addition of warm water to the condensed 
milk furnishes a palatable fluid, of the appearance and composition of 
fresh warm milk. 

Fresh milk, boiled and corked up in bottles to exclude the air, will 
keep for a considerable length of time. To prevent fermentation, some 
sulphite of lime may be added to it. For temporary preservation of 
milk in the summer-time, especially when intended for food for infants, 
a little bicarbonate of soda and sugar may be used. 

Cheese contains all the constituents of milk, except the water and 
some salts and lactine removed by expression. In the preparation of 
cheese the caseine of the milk is coagulated by rennet, the butter and a 
portion of the lactine and salts are entangled in the meshes of the 
caseine, and the mass is subjected to powerful compression. The pe- 
culiar flavor and quality of the cheese depend upon the nature and rich- 
ness of the milk, and upon certain fermentative changes which take 
place, developing volatile, odorous, and sapid constituents. The fob 



; 



ALIMENTS— ANIMAL. 27 

lowing table of the composition of cheese illustrates its nutritive 

qualities : 

Water 30.8 

Albuminates 33.5 

Fats 24.3 

Salts 5.4 

It is evidently a concentrated food. The digestibility of cheese de« 
pends in part on its freshness, in part on its composition. When fresh 
and of good quality, it does not ordinarily disagree with the stomach. 
A small quantity of cheese taken after dessert in some cases assists 
digestion ; but many dyspeptics and persons of weak digestion cannot 
make use of it under any circumstances. 

Ivoumiss. — This is a fluid obtained from mare's-milk by fermenta- 
tion, and constitutes the principal part of the food of the people inhab- 
iting a portion of Tartary. It contains alcohol, lactic acid, sugar, 
caseine, fat, salts, carbonic acid, and water. In addition to these con- 
stituents, ascertainable by chemical analysis, koumiss contains fragrant 
compounds, volatile, the product, probably, of the decomposition of the 
fat and the reaction of the acids on the alcohol, forming ethers. Kou- 
miss of good quality may also be prepared from cow's-milk by the pro- 
cess of fermentation, but, as mare's-milk is more nearly allied to human 
milk in composition, it is to be preferred in the preparation of this ali- 
ment. By variations in the method of preparation, different kinds of 
koumiss are produced, as, for example, thick koumiss, whey-koumiss, 
skimmed-koumiss. According to the different stages to which the pro- 
cess of fermentation is carried, there result three degrees of quality, No. 
1, No. 2, and No. 3. No. 2 differs from No. 1 in containing more alcohol 
and carbonic acid, and less sugar and caseine. These constituents, 
especially the carbonic acid, impart a liveliness to the fluid, so that it 
effervesces like champagne. In No. 3 the fermentation having proceeded 
further, butyric, succinic, and acetic acids are produced, and the spar- 
kling quality is enhanced. 

Koumiss is prepared from milk, by the addition of a ferment — some 
koumiss obtained from a previous fermentation or dried koumiss. It 
is allowed to ferment three days at a temperature of from 70° to 80° 
Fahr. It is then a bluish-white liquid, having a sharp, acidulous taste, and 
none of the characteristics of ordinary milk. If heated to 100° Fahr., 
fermentation is definitely arrested. If before being heated it is bot- 
tled, products corresponding to 1, 2, and 3, named above, are the re- 
sult. Allowed to stand after three days' fermentation, it separates 
into three layers : the inferior, caseous ; the middle, an acid water ; and 
the uppermost, a whitish fluid, the best koumiss. The alcoholic strength 
is of course determined by the stage of fermentation. The koumiss of 
two days' fermentation is feeble in strength, and hence the product of 
three days' fermentation is preferable for medicinal use. 



28 



RESTORATIVE AGENTS. 



The quantity of koumiss administered depends on the condition of 
the patient. In cases of feeble digestion, this being the only article 
of food, an ounce every hour will be a sufficient quantity. With in- 
creased facility in its digestion and assimilation, from a quart to a gal- 
lon a day may be taken. When it is used in connection with other food, 
a tumblerful may be administered after each meal. It is estimated 
that each quart of koumiss contains four ounces of solid food. 

The tolerance of the stomach to koumiss is remarkable, even in cases 
of gastralgia. It improves the appetite, and excites the action of the 
kidneys. The patients experience a pleasing exhilaration, due probably 
to the combined action of the carbonic acid and the alcohol. Decided 
intoxication undoubtedly may result from the use of a large quantity 
by any one unaccustomed to it. It also causes somnolence during the 
day, and favors sleep at night without leaving any after-headache. Its 
most important action is the increase of the body nutrition ; and hence 
its utility in the treatment of phthisis, indigestion, and the various ca- 
chexias. Jagielsky says that he has had patients gain as much as ten 
pounds a month when no other food was taken. 

Fish. — A great many varieties of fish are used as foods to which it is 
necessary to allude in general terms only. Salted fish is not a suitable 
article of food for the sick : it is difficult of digestion, and possesses 
but slight nutritive value. Fresh fish, however, properly cooked, is, as 
a rule, easy of digestion, and furnishes a pabulum of a valuable kind in 
diseases of certain textures. The following is the composition of fish as 
compared with beef, according to the analysis of Fr. Schulze : 



CONSTITUENTS. 


Beet 


Fish. 




15 

4.3 

1.3 

1.6 
traces. 

1 
77.5 


12 




5.2 




1 




1.7 








<( 


Water 


£0.1 







The commonly-received opinion, that fish is a more highly-phosphorated 
food than beef, does not receive support in this analysis. White-fish, 
shad, bass, and fresh mackerel, are more suitable for the sick than cod, 
salmon, or eels. They should be prepared and eaten as soon as possible 
after being taken from the water, and should be either broiled or boiled. 
Only at the time of the ripening of the milt and roe 'are fish in a suit- 
able condition for the dietary of invalids. At the time of spawning, and 
immediately after, the flesh of fish is watery and semi-gelatinous. 

Oysters rank among the most digestible of foods, and are usually 
easily borne by the most delicate stomach. According to Fonssagrives 
the French oyster contains about 12.6 parts of solid matters, consisting 



ALIMENTS— VEGETABLE. 29 

of osmazome, chlorides of sodium and magnesium, sulphates of lime 
and magnesia, fibrine, albumen, and gelatine. They are more easily and 
quickly digested when eaten raw, or broiled, but stewed is the most 
common form for use in disease. In cases of great irritability of the 
Btomaoh, the most easity-borne oyster-soup is prepared by the addition 
of the liquor to boiling milk. 

Vegetable. — The most important members of this class of foods are 
the cereal grains — wheat, rye, corn, rice, buckwheat, oats, and barley. 
The universality of its consumption and its nutritive value place wheat- 
bread in the first position as an article of diet. The composition of 
wheat-flour is as follows : 

Water 14 

Fatty matters 1.2 

Gluten 12.8 

Albumen 1.8 

Dextrine, sugar 7.2 

Starch 59.7 

Cellulose 1.7 

Salts (potash, soda, lime, magnesia, phosphoric acid, etc.) 1.6 

In the preparation of wheat-flour, the bran is separated. Important 
constituents of the wheat are thus removed, as the following analysis 
of the bran shows : 

Water 10.3 

Fatty matters 2.82 

Gluten 10.84 

Albumen 1.64 

Dextrine, sugar 6.8 

Starch 22.G2 

Cellulose 43.98 

Salts 2.52 

The internal envelope of the wheat-grain contains also a ferment, 
known as cerealine, which has very active properties. As the propor- 
tion of bran to flour is as sixteen to eighty, it is obvious that consider- 
able loss accrues in the preparation of superfine flour. Wheat-bread 
made from superfine flour is easy of digestion, owing to its lightness and 
sponginess permitting a rapid diffusion of the gastric juices through 
every part of it. Most of it is also available for nutrition ; there is 
little residuum ; hence the constipation which attends its use in large pro- 
portion relatively to the other constituents of the diet. When flour is 
unbolted (bran not separated), an increase of nutritive value is obtained, 
at the expense, however, of digestibility. A large part of the bran, 
probably, resists the action of the gastric juice, and hence, irritating the 
mucous membrane, increases by reflex action the secretions and peri- 
staltic movements. 



30 RESTORATIVE AGENTS. 

Whole wheat-grains, under the name of " cracked wheat" is fre- 
quently prescribed as an article of diet for invalids. It is boiled until 
the envelope of the grain is burst open, and is eaten with cream and 
sugar. Obviously such a combination forms a food of great excellence. 
The special advantage which it possesses, besides its nutritive value, is 
its laxative action. 

Ordinarily, wheat-bread made of superfine flour is to be preferred 
for the use of invalids. To obviate the constipating action of such bread, 
and to obtain a laxative effect, various expedients are adopted. Bran, 
rye, and corn meal, and, in some kinds of bread, molasses, are added to 
the dough, forming those varieties known as Graham bread, brown 
bread, and Boston brown bread. 

The important quality of lightness is imparted to wheat-bread by 
thorough incorporation of carbonic-acid gas with the dough. Two pro- 
cesses are employed for this purpose : By the addition of yeast, fermen- 
tation takes place at the expense of a portion of the starch, and carbonic 
acid and alcohol are produced. By mechanical means, carbonic acid 
obtained from other sources is mixed with the flour. The latter is 
known as " aerated bread." Obviously, the mechanical process is more 
economical because there is no loss of flour. It furnishes usually a 
lighter and drier bread, and is more easily digested. Bread made by 
the fermentation process is not unfrequently moist and heavy, and sour, 
because the fermentation has proceeded beyond the alcoholic stage. 
" French bread " is lighter, drier, and better baked, than ordinary baker's 
fermented bread. Warm, fresh bread is not suitable for invalids. It 
cannot be so perfectly masticated as older bread, and, not reaching the 
stomach in a state to permit diffusion through the mass of the gastric 
juices, lies unchanged for hours. 

According to Smith, the ultimate composition of wheat-bread is as 
follows : 

Water 37 

Starch 47.4 

Sugar 3.6 

Fat 1.6 

Salts 2.3 

Macaroni stewed in milk is sometimes prescribed for the sick. 
Prepared with butter, cheese, and condiments, it is not an appropriate 
food for invalids. In composition it consists chiefly of gluten, and of 
course starch — but in less proportion than in bread — and of fat. The 
cylindrical tubes in which it occurs are formed by passing the paste of 
flour (gluten) through perforated plates. 

Bread requires from three and a half to four hours for complete 
digestion. Brown bread digests somewhat more slowly. 

Barley is but rarely used as food in this country. It is occasionally 



ALIMENTS— VEGETABLE. 31 

prescribed for the sick in the form of infusion — a demulcent drink — and 
is frequently added to soup. It has the following composition (Smith) : 

Water 15. 

Starch 69.4 

Sugar 4.9 

Fat 2.4 

Salts 2.0 

Albuminous substances 6.3 

Hice is one of the most digestible of vegetable foods, requiring, when 
boiled, about one hour. Its nutritive value is not equal to wheat, be- 
cause it consists chiefly of starch. The following is its proximate con- 
stitution : 

Water 13 

Nitrogenous matter 6.3 

Starch 79.1 

Sugar 0.4 

Eat 0.7 

Salts 0.5 

Rice-water, or decoction of rice, like the corresponding preparation 
of barley, is used as a demulcent drink in fevers and intestinal disorders. 
Boiled rice is frequently prescribed as a diet for invalids with weak di- 
gestion, and is enriched by the addition of milk and cream, and eggs 
(rice-pudding). 

A comparison of its chemical composition with that of wheat or 
corn will show that it is by no means equal to them in nutritive value. 
It is obviously unfitted to sustain life alone, and hence in rice-eating 
countries it is mixed with fat or other foods supplying principles in 
which it is deficient. 

Com has the following composition (Letheby, Smith) : 

Water 14 

Nitrogenous matter (albumen) 11 

Starch •. 64.7 

Sugar 0.4 

Fat 8.1 

Salts 1.7 

It is not so readily digested as starch, requiring about three hours. 
Corn, when green, is prepared for the table by boiling, and is eaten with 
salt and butter, or milk. If young and tender, and sufficiently cooked, 
it is a digestible and nutritious food ; but, if the grain is too mature, it 
resists the action of the intestinal juices, and passes unchanged. 

The mature grain, deprived of the heart and husk, is known as 
hominy. Thus prepared and thoroughly boiled it is an esteemed 
article of diet, ranking in nutritive value a little above boiled starch. 
Mush is boiled corn-meal, and is eaten with milk, and is sometimes fried. 



32 RESTORATIVE AGENTS. 

It is important that mush be well cooked. Corn-meal is also eaten 
in the form of bread and cakes. These various preparations of corn are 
liable to cause intestinal disorders, and are hence improper in cases of 
irritable mucous membrane, and in diarrhoeal diseases. For this reason 
corn-bread is sometimes prescribed in cases of constipation dependent 
on diminished secretion of the intestinal mucous membrane, and torpor 
of the muscular layer of the bowel. The starch of corn is not unfre- 
quently prepared for invalids in the form of blanc-mange. 

Oatmeal corresponds in physical qualities and composition to corn- 
meal. Its proximate composition, according to Smith, is as follows : 

Water 15 

Nitrogenous matter 12.6 

Starch 68.4 

Sugar 6.4 

Fat 5.6 

Salts 3.0 

It is not at all generally used as an article of diet in this country. 
It is prescribed in the form of gruel as a delicate food. Boiled for a 
long time, the oatmeal swells up and thickens, forming a blanc-mange, 
which may be eaten with milk, or butter, or cream, and sugar and aro- 
matics. 

The Potato, next to wheat, is the most important food derived from 
the vegetable kingdom. Its composition -is affected by its source and 
variety, and by the soil in which it is grown. The specific gravity of 
the potato affords an index of its nutritive value, for, the heavier, the 
greater the quantity of starch it contains. For the sick, watery pota- 
toes are unsuitable. When cooked, the tuber should be mealy and dry. 
The following is the composition of the potato : 

"Water 75 

Nitrogenous matter 2.1 

Starch 18.8 

Sugar 3.2 

Fat : 0.2 

Salts .' 0.7 

According to some authorities, the potato contains free citric acid. 
The salts are rich in potash. According to Letheby, the composition 
of sweet-potato is as follows : 

Starch 16 

Sugar.... 10 

Albumen 1.5 

Gum 1.1 

Fat. 0.8 

Salts 2.9 

Water 68.2 



SPECIAL PLANS OF DIET. 



33 



These analyses indicate that the sweet potato possesses the higher 
nutritive value. 

Starch, Sago, Arrow-root, and Tapioca, differ from the preceding 
vegetable foods, in that they contain no nitrogen. They are digested 
in from one to two hours. They are largely used in the preparation of 
diets for the sick, but are insufficient in themselves to maintain for any 
considerable period the vital functions. Hence they are prepared aud 
eaten with sugar, milk, cream, butter, and aromatics. 

Turnips, Parsnips, Carrots, Onions, Asparagus, Beets, Cauliflower, 
and Cabbages, are but rarely prescribed for the sick. Nevertheless, 
some information in regard to their composition and digestibility may 
not be misplaced. According to Smith, the following represents the 
composition of 



Turnips. 


Carrots. 


Parsnips. 




91 
2.1 
1.2 

5.1 

0.6 


Water 

Nitrogenous matter. 
Fat 

Salts 


83 
6.1 
1.3 
0.2 
8.4 
1.0 


Sugar 


82 




5.8 


Nitrogenous matter. 
Fat 

Salts 


Nitrogenous matter. 
Fat 


1.1 
0.5 
9.6 
1.0 



Beets differ from the above chiefly in the quantity of sugar. The 
following is the analysis of Payen : 

Water 83.5 Nitrogenous matter 1.5 

Sugar 10.5 Pectose, etc 0.8 

Salts and pecten 3.7 

All of the members of this group are deficient in nutritive value, 
and are besides slow and difficult of digestion, requiring from three to 
five hours for complete solution. 

Bipe fruits, as grapes, apples, pears, peaches, oranges, lemons, etc., 
possess but little nutritive value, as they contain only about 10 to 15 
per cent, of solid matters. In composition they are represented by 
sugar, free acid (tartaric, citric, etc.), nitrogenous matters, and salts. 
They differ, of course, in the peculiar flavoring matters which give to 
each fruit its special taste. Dried fruits, as dates, figs, and raisins, are 
relatively much more nutritive, because they contain a larger percentage 
of sugar. Under the head of dietetic management of diseased states, 
some further remarks will be made on the use of the fresh and dried 
fruits. 

SPECIAL PLANS OF DIET. 



The food-supplies to the organism may be so managed as to secure 
very definite therapeutical results. By increasing or diminishing the 
whole amount of foods ingested, by variations in the quality and char 
4 



34 RESTORATIVE AGENTS. 

acter of them, and by the employment of some special and restricted 
methods of feeding, cures are effected not attainable by medicinal treat- 
ment. 

Denuteition. — The amount of food necessary for bare subsistence 
has been pretty accurately determined. During the siege of Paris the 
daily ration was at one time reduced to less than ten ounces of bread 
and one ounce of meat daily. Dr. Edward Smith ascertained that the 
daily amount of food barely sufficient to maintain life among the factory 
operatives must contain 2.84 ounces of nitrogenous matter and 19.25 
ounces of carbonaceous. Pettenkofer and Voit give, as the necessary 
amount of food required by an adult when at work, 5.22 ounces of nitro- 
genous and 22.38 of carbonaceous matter. Letheby furnishes the fol- 
lowing table as the result of his investigations on this point : 

Daily Diet for Nitrogenous, Carbonaceous, 

ozs. ozs. 

Idleness 2.67 19.61 

Ordinary labor 4.56 29.24 

Active labor 5.81 34.97 

The ration of the United States soldiers imprisoned at Andersonville 
consisted of one-third pound of bacon and one pound and a quarter of 
unbolted corn-meal. This amount and quality of food were insufficient 
to maintain the bodily functions in a healthy state, and hence vast num- 
bers died of scorbutus, diarrhoea and dysentery, and hospital gangrene. 
From these data we are enabled to form an estimate of the amount and 
kind of food necessary to maintain life in those cases of disease in 
which it is desirable to apply the method of denutrition. 

Physiological Effects of Insufficient Food. — Intestinal uneasiness, 
more or less pain, borborygmi, and a feeling of hunger, are among the 
first symptoms of an insufficient supply of food. The secretions of the 
intestinal canal diminish, digestion becomes difficult, and constipation re- 
sults. The respiratory movements are diminished in frequency and vol- 
ume, and the exhalation of carbonic acid notably declines. According 
to Dr. Edward Smith, while under an ordinary diet the daily excretion of 
carbonic acid amounts to thirty-four ounces, under an almost complete 
abstinence it falls in twenty-four hours to twenty-two ounces. The 
blood suffers a notable diminution in its amount ; the quantity of water 
augments, and the number of blood-globules greatly diminishes. Mean- 
while the blood loses its plasticity, and a tendency to hasmorrhagic ex- 
travasations is developed. The urinary secretion also lessens in amount : 
the urea and uric acid diminish, but the hippuric acid rather increases ; 
the chlorides after some days almost disappear, but the sulphuric and 
the phosphoric acids persist. As a result of the very obvious decline 
in the function of assimilation, the temperature of the body falls some 
degrees below the normal. The functions of the nervous centres under- 
go a marked derangement. Giddiness, vertigo, hallucinations, ensue, 



DEXUTRITION". 35 

and are coincident with a fatty degeneration of the cells of the gray 
matter. The subcutaneous fat disappears ; the muscles lose a consider- 
able part of their substance. The muscular substance of the heart 
diminishes proportionally. The bones do not suffer much loss. The 
extreme degree of loss attainable with safety is from 40 to 50 per cent, 
of the average weight. 

Therapy. — Diminution in the gross amount of aliment and a rear- 
rangement of its constituents are of the first importance in the treat- 
ment of obesity. The tendency to obesity may be hereditary or ac- 
quired. In the former it is cured with difficulty ; in the latter a suitable 
regimen will accomplish much. The fat accumulates under the skin, in 
the visceral cavities, and in the interstices of organs. Two doctrines 
have been held by physiologists with regard to the mode of production 
of fat in the organism : one, that the fat received in the food is simply 
stored up ; the other, that it is also produced by the transformation of 
some of the other constituents of the food. If the first theory contained 
the whole truth, it would be necessary only in the treatment of obesity 
to withdraw from the patient's aliment all fatty substances; but it is 
found in practice that this is insufficient, and that fat is created out of 
the starchy and saccharine elements of the food. Hence it is necessary 
in the treatment of corpulence to interdict not only fats, but the starches 
and sugar. This was the method of Hippocrates ; but it has been re- 
vived in our generation by Mr. Banting, and is now usually called San- 
tingism. As a guide to this method of treatment I quote the rules of 
Mr. Banting : 

" For breakfast, at 9 A. h., I take five or six ounces of beef, mutton, 
kidneys, broiled fish, or cold meat of any kind except pork or veal ; a 
large cup of tea or coffee, without milk or sugar ; a little biscuit or one 
ounce of dry toast ; making together six ounces of solid and nine of 
liquid. For dinner, at 2 p. m., five or six ounces of any fish except 
salmon, herring, or eels ; any meat except pork or veal; any vegetable 
except potato, parsnip, beet, turnip, or carrot ; one ounce of dry toast ; 
fruit out of a pudding not sweetened ; any kind of poult^ or game, and 
two or three glasses of good claret, sherry, or madeira — champagne, port, 
and beer, forbidden ; making together ten or twelve ounces solid and ten 
liquid. For tea, at 6 P. ir., two or three ounces of cooked fruit, a rusk 
or two, and a cup of tea without milk or sugar; making together two 
to four ounces solid and nine liquid. For supper, at 9 P. m., three or 
four ounces of meat or fish, similar to dinner, with a glass or two of claret 
or sherry and water, making together four ounces solid and seven liquid." 

Sugar, Mr. Banting finds, is one of the most active of fat-forming 
foods. His method consists in the avoidance of sugar, fat, and farina- 
ceous substances — in fact, all roots or vegetables grown underground. 
Although this system was pursued by Mr. Banting with success, it can- 
not always be persisted in without danger. The dietary is wanting in 



36 RESTORATIVE AGENTS. 

the amount both of carbonaceous and nitrogenous constituents necessary 
to the healthy action of the organism. Therapeutically it is adapted 
to the end in view — the denutrition of the body ; but it is, physiologi- 
cally considered, unsafe to be long persisted in, because insufficient for 
the work of the body. 

Aneurism. — A low diet, with absolute rest, is of great value in the 
treatment of internal aneurisms. The diet should be only sufficient to 
maintain life. The method of Valsalva consisted in such a diet and fre- 
quent and free bleedings, with rest. Mr. Tufnell's plan of diet, which 
has proved very satisfactory in this disease, consists in two ounces of 
liquid and four ounces of solid food morning and evening, and four 
ounces of liquids and six ounces of solids at noon, and with this diet- 
ary is associated absolute repose in the recumbent posture. 

To diminish the Volume of the Foetus in cases of Dystocia has 
been suggested by Merriman, Baudelocque, and Moreau, and was suc- 
cessfully practised in two cases by Depaul. The method consists in 
free abstraction of blood, and the lowest diet consistent with the exist- 
ence of life. At the present time the methods of inducing premature 
labor have been so perfected as to quite take the place of the practice 
of Depaul. 

Syphilis.— It is certainly an eminently rational expedient to relieve 
the organism of a virus by a continuous and gradual molecular destruc- 
tion and a renewal of the anatomical elements. Such is the hunger- 
cure of syphilis, an Arabic method of treating that disease. Very sat- 
isfactory results have been attained by this means ; but the self-denial 
and even suffering which it requires render it exceedingly unpopular 
with patients. 

Dry Diet. — This consists in a decided diminution or a temporary 
total suspension of liquid of all kinds. It is well known that water 
constitutes about two-thirds of the gross weight of the adult body. 
The quantity of water daily lost from the body has been estimated at 
about four and a half pounds. Dalton thinks that fifty-two fluid-ounces 
is the quantity required by a man in full health exercising in the open 
air. The difference between this and the amount of loss is made up by 
the water contained in food, especially in the succulent vegetables. 
Indeed, it is quite possible for the vegetarian, whose diet consists of 
fruits and vegetables, to receive sufficient water in this way for the pur- 
poses of his organism. 

Physiological Effects of Dry Diet. — Besides the tormenting sensa- 
tion of thirst, the food is swallowed with difficulty and the appetite is 
lost. Absorption of the interstitial fluids takes place, and the volume 
of the organs undergoes diminution. The subcutaneous veins flatten, 
and the pulse loses in tension and amplitude ; the saliva becomes 
viscid ; the urine reddens and deposits a sediment ; constipation ensues, 
and a rapid emaciation takes place (Fonssagrives). 



VEGETABLE DIET. 



37 



TJierapy. — As the withdrawal or decided diminution of fluid causes 
rapid absorption of the interstitial water, this method of treatment may 
be resorted to with advantage in cases of dropsy. It has been used with 
success in dropsical accumulations of the serous cavities, and is adapted 
to the treatment of hydrotJiorax, hydrops pericardii, and ascites. 

Fonssagrives reports two cases of diabetes insipidus (polyuria) 
decidedly benefited by the dry diet. This method of treatment is in- 
dicated in the first stage of fibroid kidney, in which disease the thirst is 
excessive, the stomach rather intolerant of fluid, and the flow of watery 
urine excessive. 

Dilatation of the Stomach, besides other appropriate treatment, is 
benefited by water-free food. That form of dyspepsia and dilatation of 
the stomach produced by excessive beer-drinking is much improved by 
abstinence from drinks of all kinds. The ice-water dyspepsia, a malady 
quite common during the summer months of this country, may be en- 
tirely relieved by dry diet. 

Vegetable Diet. — The special indications for the use of vegetable 
food are reserved for the sections on diet in special diseases. It is 
necessary, however, to say something here of the grape-cure, a method 
of treatment much in vogue in some parts of France and Germany. 

The grape-cure consists, according to Carriere, of a diet exclusively 
of grapes. They are taken many times a day to repletion. It is usual 
to commence with a pound, and progressively to increase the amount 
to two, three, six, and eight pounds, a limit which is not exceeded. The 
first grape-repast, which ma}' be the most abundant, is in the early morn- 
ing, but not as are the others, eaten in the vineyard. Another is taken 
at the time of the morning meal (corresponding to our breakfast) ; the 
next after the morning walk at the time of the dejeuner (noon), consist- 
ing of bread and water; another before the usual dinner-hour (evening), 
and finally before retiring. The treatment is continued during the five 
or six weeks of the duration of the grape-crop. 

The grape-cure is used with success in plethora of the portal circu- 
lation, diarrhoea, dysentery, hcemorrhoids, and engorgement of the 
spleen. It renders much service in the principal dyscrasise, as scrofida, 
tuberculosis, and phthisis, gout, and cutaneous diseases (Carriere). 
The influence of change of air, of new scenery, and of the hygienic rules 
enforced at these resorts, should not be ignored in an estimate of the 
value of this method. 

The composition of the ripe grape is, according to Smith, as follows : 



Soluble. 

Grape-sugar 13.8 

Tartaric acid 1.12 

Nitrogenous matter 8 

Gum, fat, etc 5 

Salts 86 

Water 79.8 



Insoluble. 

Skins, stones, etc 2.6 

Pectose.. 9 

Mineral matter 12 



38 RESTORATIVE AGENTS. 

The quantity of nitrogenous matter is insufficient for the needs of the 
organism, hence the addition of bread and water to the diet of the 
grape-cure. 

Animal Diet. — The more or less exclusive use of animal food im- 
proves the quality of the blood by increasing the number of the red 
corpuscles. The urine rises in specific gravity, and the urea and uric 
acid are increased in amount. According to Liebig, force in excess is 
developed from a diet of animal food, whence a nation of animal feeders 
must be a nation of hunters, possessing a savage disposition. Those 
who consume largely of animal food are not fat, but have a high de- 
gree of muscular activity. They are tormented by imperious venereal 
desires, and are irritable in temper. 

Therapy. — A diet of animal food is specially indicated and of great 
utility in diabetes. As the vegetables and fruits contain sugar, and 
starch which is readily transformed into sugar, they are interdicted 
in this disease. A method of treating diarrhoea long practised in 
Russia, and popularized by Trousseau, consists in the use of a pulp of 
raw meat. A bit of filet of beef is deprived of all fat and aponeurotic 
fibre, minutely divided, and beaten in a mortar until all traces of fibres 
have disappeared. It is then pressed through a fine sieve and mixed 
with sugar, conserve of roses, or suitable aromatics, or seasoned with 
salt and pepper to the taste. It may be administered in this form with 
fruit-jelly, or spread on thin pieces of bread. A beefsteak hastily 
broiled on a hot fire, so as to retain its juices, may be treated by the 
same method, or the raw beef scraped to a pulp, rejecting the fibre, 
may be thrown on to a hot skillet for a few seconds to give an odor and 
appearance of cooked meat. This method, which has been used especially 
in the treatment of diarrhceal diseases of early life, is equally efficacious 
in the chronic diarrhoea of adults. The chief objection to this mode of 
alimentation is the great frequency with which tape-worm follows. 

In states of debility arising from any cause in which it is necessary 
to supply an easily-digested nitrogenous aliment, raw beef may be used 
in this way. 

Blood is so rich in the elements of nutrition that its employment as 
a food in wasting diseases need not excite surprise. Within a few years 
it has been much used in the treatment of phthisis, the patients resort- 
ing to the butchers' shambles to quaff the blood as it flows away. On 
the part of the patients, it is supposed to possess some special curative 
power ; but it is only as a nutrient that its use is justifiable. Besides 
the unpleasant associations which must necessarily be connected with 
blood-drinking, there is danger of swallowing parasites. That it im- 
proves nutrition, often to a remarkable extent, is undeniable. It must 
therefore remain a question to be decided by the patient whether he 
will incur the risk of infection by parasites, to be benefited by drinking 
a valuable nutrient. 



MILK-DIET. 39 

As the serum of the blood contains the most important of the nutri- 
tivc elements of the blood, the use of this has been proposed in lieu of 
the latter, administering one ounce three times a day. Blood-serum is 
said to be an efficient vermifuge. It must be taken fasting. 

Milk-Diet. — The numerous and important applications of milk-diet 
in the treatment of certain forms of disease render it necessary to de- 
vote considerable space to the consideration of this subject. Milk is a 
food already prejoared, and therefore needs no intervention of unskillful 
cooks: it can be obtained everywhere; few patients are disinclined to 
take it. 

Physiological Effects of Milk-Diet. — In the use of a diet for a long 
time exclusively of milk, great difficulty is often experienced in over- 
coming the repugnance of the patient. Although as a rule it is taken 
with readiness at first, after a time it begins to pall upon the appetite, 
and the greatest resolution is necessary on the part of the patient in 
order to continue it. A distressing sense of emptiness is experienced at 
the epigastrium. The mouth becomes pasty, and the tongue is coated 
with a thick, whitish fur. Constipation, sometimes exceedingly obstinate, 
occurs, and the stools are hard and of an ochre-yellow color. Occasionally 
diarrhoea is produced, but this is due to the fact that the milk disagrees 
and is not digested. The urinary secretion is increased in amount, but 
this is due simply to an increased flow of water. Although milk con- 
tains all the constituents necessary for the nutrition of the bod}', when 
it is used as an exclusive article of diet in the case of those accustomed 
to a full mixed diet, a decided diminution in the weight of the body 
takes place. After a time, however, the waste ceases, and the weight 
continues at a uniform level. The interference of a milk-diet with nutri- 
tion is more decided when skimmed-milk is used — a form in which it is 
more usually administered in intestinal disorders. The pulse is quick- 
ened and the arterial tension lowered ; but a fall in the pulse-rate takes 
place when the body ceases to lose weight. A marked degree of debil- 
ity is experienced by some persons, so that they are unable to take ex 
ercise. In two cases in which I used this method with signal success 
— chronic eczema, and chronic ulcer of the stomach — the patients, both 
females, experienced vertigo and faintness, and Mitchell mentions a case 
in which from the same cause he was compelled to discontinue the milk. 
Ordinarily, however, nothing more than weakness is experienced. 

Therapy. — Pecholier, Carel, Mitchell, and all who have treated of 
the milk-cure, insist upon the suspension of all other food and drink. 
The quantity to be taken will vary with the constitutional peculiarities, 
habits of life, and probably the mental condition of the patient. As 
milk requires about three hours for its complete digestion, this furnishes 
a rule for its administration. One gill, or four ounces, every three 
hours, beginning on rising in the morning, is the rule which I have fol- 
lowed with success. As soon as the patient can take a sufficient quan- 



40 RESTORATIVE AGENTS. 

tity, one or two tumblerfuls four times a day may be ordered. From a 
quart to two quarts is the daily amount which will be taken usually by 
the patient. It is better administered slightly warm. 

In many cases of stomach and intestinal disorders, it is better to give 
skimmed-milk. The milk should stand for twenty-four hours in a cool 
place, and then all the cream which has risen should be carefully removed. 
Sometimes, says Pecholier, when crude milk disagrees with or is dis- 
gusting to the patient, it may be boiled. The digestion of the milk, 
says the same authority, when it is poorly borne, may be aided by the 
addition of lime-water, bicarbonate of soda, and other alkalies. Mitchell 
has added lime-water for tho first few days under the same circumstances, 
and, in order to overcome the patient's repugnance to the taste, has 
faintly flavored the milk with a little coffee or caramel ; but he prefers 
to give it alone as soon, as possible. My own observation has been, that 
milk is better borne when given for the first few days with lime-water, 
in proportion of one-fourth of the latter. 

For the nourishment of infants deprived of their natural food, no 
substitute is better than cow's-milk diluted with about one-third of 
water and sweetened with sugar, in order more closely to assimilate it 
in composition to the human milk. This should be given at a tempera- 
ture of 100° Fahr., and at intervals of three hours. No other food than 
milk is proper for infants up to the eighth month of life, for their diges- 
tive organs are not adapted to the digestion of the farinaceous foods so 
commonly supplied them. If the milk be rejected, the addition of lime- 
water may enable the infant to retain and digest it. 

In the treatment of disease in the adult with skimmed-milk, the time 
for suspension of the diet depends on several conditions. Carel begins 
to make additions after two or three weeks ; Pesholier when the effects 
sought for in the treatment are obtained. Mitchell formulates his method 
as follows: "My own rule, founded on considerable experience, is this: 
Dating from the time when the patient begins to take milk alone, I wish 
three weeks to elapse before any thing be used save milk. After the 
first week of the period, I direct that the milk be taken in just as large 
amount as the person desires, but not allowing it to fall below a limit 
which, for me, is determined in each case by his ceasing to lose weight. 
Twenty-one days of absolute milk-diet having passed, with such excep- 
tion as I shall presently mention, I now give a thin slice of stale white 
bread thrice a day. After another week, I allow rice once a day — about 
two tablespoonfuls — or a little arrow-root, or both, as circumstances may 
dictate. At the fifth week I give a chop once a day ; and, in a day or 
two, another at breakfast ; and after the sixth week I expect to return 
gradually to a diet which should still consist largely of milk for some 
months." My own rule has consisted in the gradual addition of other 
diet after the cessation of symptoms for which the milk-treatment was 
instituted. 



WHEY-CURE. 41 

To overcome the obstinate constipation which sometimes attends the 
milk-cure, a variety of measures have been proposed. Carel advises 
coffee in the morning. Mitchell recommends a half-grain of aloes at 
night, and Saratoga-water in the morning. I find that fifteen drops of 
the tincture of physostigma at night will often succeed, but more fre- 
quently prescribe with success a teaspoonful of Epsom salts dissolved 
in a half-tumbcrful of ice-water to be taken on rising. 

The milk-cure is especially adapted to the treatment of obstinate 
stomach-affections. It has succeeded admirably in the treatment of 
dyspepsia, gastric catarrh, gastralgia, gastric ulcer, and has procured 
marked amelioration in cases of scirrhus of the stomach. In chronic in- 
testinal indigestion, obstinate and persistent enteralgia, chronic diar- 
rhoea and dysentery, it has proved very efficacious. 

The treatment of ascites by a milk-diet appears to have been of an- 
cient origin, for Hippocrates distinctly refers to it, but the revival of the 
practice in modern times is due to Chrestian, of Montpellier, who demon- 
strated the utility of this practice in a number of cases (Fonssagrives). 
Pecholier and Chairon also report cases of success treated by this 
method. In cases of ascites the result appears to be due to the profuse 
alvine and urinary discharges which are caused by the milk-diet in this 
disease. Pecholier also reports cases of general anasarca due to cardiac 
disease, much benefited by this treatment. In England, Donkin has 
issued a monograph on the skim-milk treatment of albuminuria, with 
successful cases. This method has also been extended to diabetes, and 
reports of cures are not wanting. 

Eczema, connected with acid indigestion, has been successfully 
treated by an exclusive skim-milk diet in my hands, and Mitchell reports 
an analogous case. Gout and gouty affections have also been much 
improved, and the diathesis apparently removed, by a persistent use of 
the milk-cure. Lastly, aneurism and cardiac disease (irregular and 
tumultuous action due to valvular lesions) have been benefited by a 
milk-regimen. 

Whey-Cure. — This mode of treatment is conducted in the moun- 
tain health-resorts of Switzerland and Germany, and is usually connected 
with the grape-cure. As whey contains so little of the nutritious ele- 
ments of the milk, we may conclude with Lebert that the hygiene and 
climate of these mountain-resorts do everything for the patients, and if 
they improve they do so in spite of the whey. 

Koumiss-Cure. — Koumiss differs from whey in containing the nutri- 
tive constituents of milk, and from milk itself in the important respect 
that it is in addition an effervescing alcoholic fluid. Koumiss possesses 
great value in the treatment of phthisis, chronic bronchitis, the lore 
stage of fevers, the stage of convalescence from acute diseases, and in 
fact in all adynamic states in which the combined effect of alcohol and 
nutrients may be desirable. 




42 



RESTORATIVE AGENTS. 



Butteemilk-Cure. — To the efforts of Dr. Ballot, of Rotterdam, is 
due the knowledge we now possess of the value of buttermilk as a food 
for infants. The relative composition of buttermilk and mother's-milk 
is given in the following table : 



CONSTITUENTS. 


Buttermilk. 


Mother VMilk. 




43.8 

23.6 

2.0 

5.6 

921.75 

78.25 

2.75 


34 3 




48 2 




23 3 


Salts 


2.3 




883 6 




116.4 




nil 







It is probably in consequence of the presence of lactic acid, as Dr. Ballot 
suggests, that buttermilk is easily digested. His mariner of preparing 
the food for infants is as follows : To a pint of buttermilk is added a 
spoonful of wheat-flour. This is boiled a few minutes. The pap must 
be thin. To this quantity of buttermilk, after it is boiled, is added half 
a drachm of sugar. It should have a sweet taste. 

In the beginning some teaspoonfuls are given to habituate the infant 
to the smell and taste, but as soon as possible it should be administered 
in a nursing-bottle. The temperature should be about 96° Fahr. When 
the infant acquires. a taste for the preparation, it may be given ad libi- 
tum twice a day. 

Buttermilk-cure may be substituted for the milk-cure in cases of 
stomach-disease, in which the former has proved so successful, and in 
cases of albuminuria and diabetes. In consequence of the large propor- 
tion of lactic acid which it contains, buttermilk is more especially indi- 
cated in diabetes. 

Infant-Feeding. — It has already been stated that fresh milk of the 
cow is the best substitute for the mother's-milk. Some additional obser- 
vations as to the management of cow's-milk, and as to the substitutes 
therefor, may, however, be necessary. There can be no doubt that cow's- 
milk is better than goats' or asses', as a rule, although there are infants 
who thrive on the two last-named better. In the large cities where it 
is impossible to procure fresh milk, condensed milk is an efficient sub- 
stitute. As in the preparation of this the temperature is raised to near 
the boiling-point of water, it undergoes no change, and can be used 
when fresh milk is not to be procured, or cannot be preserved. Con- 
densed milk is ready for use by mixing it with water in the proportion 
of one teaspoonful of milk to seven of warm water. When the addition 
of lime-water is desirable, it can be added in proper proportion. In the 
author's experience, children, with few exceptions, do well on condensed 
milk. 



INFANT-FEEDING. 43 

Caseine is that constituent of milk which is most likely to disagree 
with infants. Dilution with water, lime-water, barley-water, etc., is not 
(infrequently effective in securing t lie digestion and absorption of the 
caseine ; but some infants are unable to digest it at all. Various expedi- 
ents are resorted to when the caseine fails entirely of digestion. Cream 
diluted with barley-water sometimes succeeds extremely well. The in- 
digestion of the caseine of a given specimen of milk may be due to an 
insufficient quantity of cream ; this defect can be obviated by adding it 
artificially. When the infant is not nourished sufficiently, and yet does 
not pass undigested caseine, the proportion of cream is probably too low. 
To assist the digestion of caseine, Jacobi recommends that a little well- 
sweetened oatmeal-gruel be given the infant before taking the bottle, 
or be mixed with the milk. His method of preparing the food is as 
follows : 

" A teaspoonful of either oatmeal or barley is boiled in from three 
to six ounces of water, with some salt, for twelve or fifteen minutes, 
the decoction to be quite thin for very young infants, thicker for later 
months, and then strained through a linen cloth. Infants of four or six 
months are to have equal parts of this decoction, which ought to be 
made fresh for every meal ; and boiled and skimmed cow's-milk and 
sugar are to be added. At an early age, the thin decoction ; at a later, 
the milk ought to prevail in the mixture, which ought to be given at a 
temperature of 80° to 90°; ought to be neutralized, when acid, with a 
few grains of bicarbonate, or carbonate of potassa or soda, and, until 
infants are eight or ten months old, thin enough to be taken through a 
nursing-bottle." 

Various substitutes have been proposed for cow's-milk; but they 
are at best constructed on doubtful principles, and vary greatly in com- 
position. Liebig's preparation has had the greatest celebrity, because 
of the reputation of its inventor, rather than of its intrinsic merit. It 
is prepared as follows : An ounce of wheaten flour is mixed with ten 
ounces of milk ; it is then boiled for ten minutes, removed from the fire, 
and allowed to cool to 90° Fahr. An ounce of malt-powder containing 
, fifteen grains of potassium bicarbonate, and two ounces of water, are 
then stirred into it, and the vessel, covered, stands for an hour and a 
half at a temperature of 100° Fahr. It is boiled for a few minutes 
again, and then strained, when it is ready for use. The object of the 
malt is to transform the starch into glucose. 

Chambers recommends the following when the artificial feeding; of 
the infant begins : " Cow's-milk should at first be mixed with half its 
bulk of soft, pure, tepid water, in each pint of which has been suspend- 
ed a drachm of sugar-of-milk, and two grains of phosphate of lime, 
finely-powdered. If the milk has been partially skimmed, as is often 
the case in cities, then a tablespoonful of cream should be added to 
each pint." Smith, whose authority in questions of infant therapeutics 



44 RESTORATIVE AGENTS. 

is admitted, also advises the addition of cream to ordinary cow's-milk, 
and carbonate of potassa or lime-water. At the expiration of six 
months the milk should be given undiluted. An infant's food should 
always be raised to the temperature of 95° Fahr. Regularity in the 
time of feeding is of very great importance: for the first six weeks, 
every two hours, and subsequently, every three hours. 

ALIMENTATION IN DISEASES. 

Aliment in Acute Inflammations and Fevers. — The febrile state 
induces serious changes in the constitution of solids and liquids. The 
interstitial fat disappears from the tissues, which become soft and watery. 
The muscles become flabby and pale, and decline in contractile energy. 
Digestion is feeble, or suspended, or abnormal, and the food supplied is 
either rejected or enters the blood in an imperfectly-prepared state. 
The blood suffers material alterations ; the red corpuscles diminish in 
number ; the fibrine increases, and the products of imperfect tissue- 
metamorphosis accumulate. The urine is usually scanty, and high- 
colored, and loaded with uric acid and urates. The chlorides more or 
less diminish in or disappear from the urine, but accumulate in the in- 
flamed tissues. The excretion of phosphates is increased. In the tis- 
sues, the seat of organic alterations, rapid but imperfect metamorphosis 
ensues, and on the one side pathological materials crowd the interstices 
in the anatomical elements, and on the other the products of waste 
struggle for elimination. Avoiding further speculation as to the fever- 
process, it will suffice to state that an enormous increase of the urea- 
discharge takes place, and that the organs and tissues of the body 
undergo a granular disintegration, which has been designated " paren- 
chymatous degeneration ; " or, as it may be stated, the increased tem- 
perature of fever represents an enormous consumption of the nitrogenous 
elements. The higher the range of temperature, as a rule, the more 
extensive the parenchymatous degeneration. 

In fevers and inflammations not of the digestive tract, the most 
useful aliments are milk and beef-tea. These should be given at inter- 
vals determined by their rate of digestibility, usually about every three 
hours. Fresh milk only should be used, and, if the stomach be irritable, 
it may be diluted with one-half to one-fourth of lime-water. It has 
been conclusively demonstrated that fresh milk is the most suitable 
aliment in typhoid, and it may be depended on wholly (Johnson). It 
is equally applicable as the aliment in scarlatina, partly as a nutrient, 
and partly as a diuretic, for in this disease one of the chief dangers is 
from arrest of the urinary secretion. 

The author is convinced that beef-tea and beef-essence are too 
exclusively used in the treatment of the fevers and inflammatory dis- 
eases. As an aliment, beef-tea is much inferior to milk, and it is also 



ALIMENTATION IN DISEASES. 45 

more difficult of digestion. It is not unusual to see, in cases of typhoid, 
the beef-tea floating on the peculiar dejections of this disease. It ought, 
therefore, never be used as the exclusive aliment in typhoid cases. 
Another fallacy of a very dangerous kind is current in domestic prac- 
tice, viz., the belief that beef-tea, which gelatinizes on cooling, is espe- 
cially rich in nutritive elements. Such beef-tea consists chiefly of 
gelatine, which has very little value as a nutrient. 

FORMULAE FOR ANIMAL BROTHS. 

" Beef-tea. — A pound of lean beef should be freed from fat, tendon, cartilage, 
bone, and vessels ; it must bo chopped up fine, and put in a pint of cold water to 
digest for two hours. It should simmer on the range or stove for three hours, 
but the temperature should not exceed 160° Fahr. The water lost by evapora- 
tion should be made up by the addition of cold water, so that a pint of beef-tea 
should represent one pound of beef. It should be strained, the beef being care- 
fully expressed. A wineglassful every three hours is a suitablo quantity for 
administration in ordinary acute cases. 

" Mutton-Broth. — Lean loin of mutton, one pound, exclusive of bone ; water, 
three pints. Boil very gently till tender, throwing in a little salt and onion 
according to taste. Pour out the broth into a basin, and, when it is cold, skim 
off all the fat. It can be warmed up as wanted. 

41 Chicken-Broth. — Skin, and chop up small, a small chicken, or half a large 
fowl, and boil it, bones and all, with a blade of mace, a sprig of parsley, and a 
crust of bread, in a quart of water, for an hour, skimming it from time to time. 
Strain it through a coarse cullender." 

The digestibility of these animal broths is improved by the addition 
of pepsin and muriatic or lactic acids. Beef-essence, obtained by pound- 
ing finely-divided beef in a mortar until the nutritive elements are 
separated from the fibre, may be administered instead of the broths 
above described. Essence of this kind may be mixed with sherry or 
other wines, whiskey, or brandy, provided alcoholic stimulants be also 
indicated. The meat solution which Leube employs so successfully in 
the treatment of gastric ulcer and other stomach-diseases, is prepared 
by digesting meat, with muriatic acid and pepsin, in air-tight vessels, 
at a high temperature. By this process the meat is converted into 
peptones, ready for absorption. 

FORMULAE FOR DIET-DRINKS. 

"Wine -Whey. — Put two pints of new milk in a saucepan, and stir it over a 
clear fire" till it is nearly boiling ; then add a gill of sherry, and simmer for a 
quarter of an hour, skimming off the curd as it rises. Then add a tablespoonful 
more sherry, and skim again for a few minutes. 

u Flaxseed-Tea. — Flaxseed, whole, one ounce; white sugar, one ounce ; liquor- 
ice-root, half an ounce ; lemon-juice, four tablespoonfuls. Pour on these mate- 



46 RESTORATIVE AGENTS. 

rials two pints of boiling water ; let them stand in a hot place four hours, and 
then strain off the liquor. 

'■'•Barley - Water. — Wash two ounces of pearl-barley with cold water. Then 
boil it for five minutes in some fresh water, and throw both waters away. Then 
pour on two quarts of boiling water, and boil it down to a quart. Flavor with 
thinly-cut lemon-rind, and sugar to the taste ; but do not strain unless at the 
patient's request." 

Other foods frequently prescribed for the inflammatory and febrile states 
are wine-whey and " egg-nogg," or " egg-flip." To a pint of boiling milk add 
four ounces of sherry; strain and sweeten the whey to the taste. This is a 
grateful subacid drink, but slightly nutritive. Egg-nogg may be prepared as 
follows : " Scald some new milk by putting it, contained in a jug, into a sauce- 
pan of boiling water, but it must not be allowed to boil. "When quite cold, beat 
up a fresh egg with a fork in a tumbler with some sugar ; beat quite to a froth, 
add a dessert-spoonful of brandy, and fill up the tumbler with scalded milk." 
This may be used in alternation with beef-tea, or exclusively in acute inflamma- 
tory or febrile affections, but the interval of its administration should not be 
shorter than three hours. Milk and egg may be served separately wittrwine or 
brandy, as follows: "To one tablespoonful of brandy, or one wineglassful of 
sherry, in a bowl or cup, add powdered sugar and a very little nutmeg to taste. 
Warm a breakfast-cup full of new milk and pour it into a spouted jug. Pour 
the contents from a height over the sugar, wine, etc. The milk must not 
boil." 

" Beat up with a fork an egg till it froths ; add a lump of sugar and two 
tablespoonfuls of water ; mix well, pour in a wineglass of sherry, and serve be- 
fore it gets flat. Half the quantity of brandy may be used instead of sherry." 

The foregoing are the most accessible and the most nutritious ali- 
ments for the acute stage of fevers and inflammations. They contain 
the materials necessary to supply the loss taking place in the organism 
at large, and to repair the damage to tissues in the state of inflamma- 
tion. 

Aliments in Diseases of the Digestive Organs. — In acute and 
chronic affections of the digestive organs, especially the latter, the skim- 
milk treatment, already described, possesses the highest value. "When 
the trouble is localized to the stomach and is of an acute character, 
only the most easily-digested aliments are borne, as, for example, milk 
and lime-water, barley-water, tamarind- whey, carbonic-acid water, effer- 
vescent lemonade, etc. The following formulas are useful : 

" To a tablespoonful of pearl-barley, washed in cold water, add two or three 
lumps of sugar, the rind of one lemon, and the juice of half a lemon. On 
these pour a quart of boiling water and let it stand for seven or eight hours. 
Strain it." 

" Boil an ounce of tamarind-pulp with a pint of milk, and strain." 
" Squeeze two large lemons, and add a pint of spring or cistern water to the 
juice and three or four lumps of white sugar. When required for use, pour 
half of it into a tumbler, and add half a small teaspoonful of carbonate of soda ; 
stir and drink while effervescing." 



ALIMENTATION IN DISEASES. 47 

In the chronic affections of the stomach, when digestion is feeble, 

especially of the nitrogenous elements (deficiency of gastric juice), 
such aliments as boiled rice, tapioca, arrow-root, unfermented bread 
(aerated bread), and the farinaceous vegetables, are indicated, for these 
foods are digested chiefly in the small intestine. Cases of acidity and 
heart-burn, dependent on the fermentation of the starchy and fatty ele- 
ments of the food, require abstinence from the articles containing them. 
The acid fruits and vegetables (apples, peaches, tomatoes, etc.) are to 
be preferred under such circumstances to the farinaceous foods. An 
acid wine (Rhenish or Catawba), taken at the principal meal, will often 
correct the acidity derived from the fermentation of starch and fat. 

In intestinal indigestion, summer diarrhcea, and cholera infantum, 
it is necessary to supply those foods which undergo solution in the 
stomach, in compliance with the fundamental therapeutical principle of 
giving a suffering organ (the intestine) rest. Starches and fats should 
therefore be withheld. Bread, arrow-root, potato, beans, peas, butter, 
and other fats, increase the disease, because on reaching the affected 
organ they are not finally digested, but act as irritants. This result is 
well seen in the summer diarrhcea of infants. Milk, eggs, animal broths, 
broiled or raw beefsteak, oysters, white-fish, are suitable aliments under 
these circumstances. Similar rules obtain in the treatment of jaundice 
from catarrh of the gall-ducts and of biliary concretions. The starches 
and fats are especially active in setting up those local disturbances 
which result in the production of jaundice by extension of the catarrhal 
process from the duodenum along the hepatic duct. The use of fat and 
oil has an immediate result in favoring the crystallization of the choles- 
terine, or in causing inspissation of the bile. 

Cases of chronic diarrhoea are sometimes remarkably benefited by 
a diet of grape-juice, peaches, and such succulent vegetables as tomato, 
celery, and raw cabbage. It is probable that the cases so benefited are 
really scorbutic in character. The author has known many obstinate 
cases of summer diarrhcea of infants to be improved by the addition of 
ripe peaches to the milk-diet. 

A proper regulation of the diet is of great importance in the treat- 
ment of habitual constipation. This usually depends on deficient 
secretion, or torpor (a paretic state) of the muscular layer of the intes- 
tines. Corn-bread, cracked wheat, oatmeal, bread of unbolted flour, 
fruits, and such vegetables as green corn, tomatoes, and celery, are indi- 
cated. Those troubled with habitual constipation, to a moderate extent, 
may overcome it by the daily use at dessert of a f ew almonds and raisins, 
about six of each. Haemorrhoids due to congestion of the portal vein, 
or to constipation, is much benefited by the grape-cure, or a diet of 
fruits and succulent vegetables. 

Aliment ix Cachectic States. — To store up fat in the tissues and 
to increase muscular power, the diet must consist of both nitrogenous 



48 RESTORATIVE AGENTS. 

and carbonaceous elements. The fats themselves hold the first place as 
fat-forming foods. Those most frequently employed for this purpose 
are the fat of meat, butter, olive-oil, cream, and milk. Sugar and sac- 
charine fruits and vegetables rank next in importance as fat-formers. 
The organism has the power of transforming starch into fat, whence 
bread, potato, pastry, rice, arrow-root, etc., belong to this class. The 
malt liquors undoubtedly possess an extraordinary energy in the same 
direction, hence the use of beer and ale by nursing- women ; but it is un- 
doubtedly true that milk is better for increasing the production of milk. 
Less force is lost in the conversion of cow's milk into human milk than 
in the complex process needed for transforming the nutritive elements 
of malt liquor. The same fact is true in regard to the relative facility 
of the appropriation of fatty aliment and of the conversion of saccharine 
and farinaceous food into fat. It is also true that, for the increase of 
muscular power, muscular tissues and juices are more easily applied by 
the organism. 

In the scrofulous, mercurial, p>lur>ibic, syphilitic, and paludal ca- 
chexia?, and in phthisis, a combination of the flesh and fat-forming 
foods is necessary. The hunger or denutrition cure, as already ex- 
plained, may be applied to the treatment of these cachexia?, the object 
being to produce such waste and molecular changes as to cause the 
elimination of the morbific matters. On the other hand, the object 
sought to be accomplished in these states of disease and in phthisis, 
by improving the body nutrition, is to supplant by fresh material the 
lesions of the anatomical elements. 

In rickets {mollities ossium) it is necessary to supply a food rich in 
phosphate of lime and other phosphate salts. Oatmeal, bread of un- 
bolted flour, cracked wheat, etc., should be added to the dietary. 

Gout, rheumatism, and the so-called uric acid diathesis, require a 
diet composed chiefly of farinaceous vegetables and acid fruits. Ani- 
mal food and saccharine substances are contraindicated in these dis- 
orders. 

In no disease is the influence of diet more conspicuous for good or 
evil than in diabetes. I have already alluded to the milk-cure, revived 
by the Montpellier school and popularized in England by Dr. Donkin. 
All saccharine substances and fruits and vegetables containing them, 
and all farinaceous foods the starch of which is easily convertible into 
dextrine and sugar, are injurious in diabetes. In this prohibition are 
included bread, potato, beets, beans, peas, sugar, milk, pastry, and sweet- 
meats of all kinds. Tomatoes, celery, and raw cabbage, are not objec- 
tionable. In order to compensate for the loss of bread, the greatest 
deprivation endured by these diabetics, gluten and almond bread are 
now prepared. To supply the deficiency in the alimentation of diabe- 
tics caused by the withdrawal of the starch elements of the food, fats 
must be used, as butter, olive and cod-liver oil, fat of meat, cream, etc. 



ALIMENTATION IN DISEASES. 49 



FORMULAE FOR VARIOUS ARTICLES OF DIET. 

Lemonade. — " Put tlio juice of a lemon to a pint of water, in which an ounce 
of sugar has been dissolved, then add the white of an egg and froth it up. It 
may be iced." 

Farina- Gruel. — " Stir two tablcspoonfuls of farina into a quart of water in a 
milk saucepan ; let this boil until it has grown quite thick ; add a pint of milk, a 
little salt, and let it boil fifteen minutes longer; turn out into a bowl, and sweeten 
to taste.'' 

Oatmeal- Gruel. — "Put a pint of boiling water into a saucepan; into this stir 
a couple of tablcspoonfuls of oatmeal until quite smooth; let this boil well for 
ten or fifteen minutes, season with salt, then strain through a strainer, and add 
a little port wine and sugar, if the patient may have it." 

Corn-Meal Milk-Gruel. — "Sweeten a quart of milk, and stir in two table- 
spoonfuls of corn-meal. This must be carefully cooked, as the meal is apt to 
scorch, and must be stirred while cooking. A little nutmeg grated on top after 
it is done makes a pleasant flavor. If the gruel is desired thick, more meal will 
be needed." 

Tapioca Jelly. — " One cup of best tapioca put to soak with a pint of cold 
water ; when soft put in a saucepan with one cup of sugar, the rind and juice 
of one lemon, a little salt, one pint more water ; stir until it boils ; turn into a 
mould ; set to cool ; add one glass of wine if desired." 

Sago. — "Put half an ounce of sago into an enameled saucepan with three- 
quarters of a pint of cold water, and boil gently for an hour and a quarter. 
Skim when it comes to a boil, and stir frequently. Sweeten with a dessert- 
spoonful of sifted loaf-sugar. If wine be ordered, two dessert-spoonfuls; and, if 
brandy, one dessert-spoonful." 

Arrow-root. — " Mix two teaspoonfuls of the best arrow-root with half a wine- 
glassful of cold water ; add a pint of boiling water ; put it into an enameled 
saucepan, and stir over the fire for three minutes. Sweeten with three tea- 
spoonfuls of sifted loaf-sugar. Add either a wineglassful of white wine, or a 
tablespoonful of brandy, if permitted." 

Arrow-root Hillc. — "Mix two teaspoonfuls of arrow- root with a wineglassful 
of new milk ; add half a pint of boiling milk ; put it into an enameled sauce- 
pan, and stir over the fire for three minutes. Sweeten with a dessertspoonful 
of sifted loaf-sugar." 

Whipped Cream. — " Beat half a pint of fresh double cream with a whisk, add 
a dessertspoonful of very finely-powdered loaf-sugar, and twenty drops of essence 
of vanilla or any other flavoring ; when firm it is ready for use, but much improved 
by being on the ice for an hour or two." 

Corn-Starch Pudding. — "One quart of milk, four tablespoonfuls of corn- 
starch, four eggs, one tablespoonful of butter, six tablespoonfuls of sugar. Dis- 
solve the corn-starch in a little cold milk, and, having heated the rest of the milk 
to boiling, stir this in and boil three minutes, stirring all the time. Take from 
the fire, and while still hot put in the butter. Set away until cold. Beat the 
eggs very light, whites and yolks separately. Stir the sugar and any flavoring 
desired in the yolks and then add the beaten whites, and stir in the corn-starch, 
beating thoroughly to a smooth custard. Turn into a buttered dish and bake 
half an hour. To be eaten cold." 

Beef-Juice. — " Broil quickly some pieces of reund or sirloin, of a size to fit 
5 



50 RESTORATIVE AGENTS. 

in the cavity of a lemon-squeezer. Both sides of the beef should be quickly 
scorched to prevent the escape of the juices, but the interior should not be fully 
cooked. As soon as ready, the pieces should be pressed in the lemon-squeezer, 
previously heated by being dipped in hot water. The juice, as it flows away, 
should be received into a hot wineglass, and, after being seasoned to the taste 
with salt and a little Cayenne pepper, eaten while hot. If preferred, the juice 
may be frozen." 

Meat-Tea. — "Put one pound each of beef, mutton, and veal, cut into small 
pieces, into three pints of cold water. It should simmer for three or four hours, 
but not boil. "When finished, the tea should be carefully strained, and seasoned 
with salt, and Cayenne pepper if preferred." 

Cream-Sowp. — " Take one quart of good stock (mutton or veal), cut one onion 
into quarters, slice three potatoes very thin, and put them into the stock with a 
small piece of mace ; boil gently for an hour ; then strain out the onion and 
mace ; the potatoes should, by this time, have dissolved in the stock. Add one 
pint of milk, mixed with a very little corn-flour to make it about as thick as 
cream. A little butter improves it. This soup may be made with milk instead 
of stock, if a little cream is used." 

Oatmeal- Soup. — " Put two ounces of oatmeal in a basin, pour over it a pint 
of cold water, stir it, and let it stand a minute ; then pour over it, quickly stir- 
ring all the time, a pint of good broth, pour through a fine strainer into a sauce- 
pan, taking care that none of the coarse part of the meal goes into the soup. 
Boil the soup for ten minutes, season and serve." 

Nutkient Enemata. — Itnot unfrequently happens that the stomach 
will not receive and dispose of nutrient materials, when it becomes 
necessary to employ nutrient rectal injections. It has been proposed to 
treat tclcer of the stomach by absolute rest of the organ, and the intro- 
duction of foods by the rectum. In cases of excessive irritability of the 
stomach the same practice is sometimes necessary. (Esophagotomy 
and gastrotomy, as also wounds of the stomach, may render the use of 
nutrient enemata indispensable to save life. It should not be forgotten 
that the rectum is not an organ of digestion ; hence nutrient enemata 
must contain the materials for artificial digestion. Furthermore, the 
mucus and fluids of the rectum are alkaline in reaction. To secure 
rapid osmosis, therefore, the enemata should have an acid reaction. 
The following formula is suitable for the purpose : 

Beef-tea, prepared as before described, four ounces ; hydrochloric 
acid, ten minims ; glycerole of pepsin (Scheffer's), two drachms. 

If the rectum is irritable, ten to twenty drops of the tincture of 
opium may be added to the injection. If stimulants are indicated, 
brandy may also be added. The rectum soon becomes intolerant of 
injections ; hence, the greatest care should be used in practising them, 
to avoid sudden distention of the bowel, and frequent introduction of 
nutrient materials should be avoided. Five times in the twenty-four 
hours should be the maximum — for artificial digestion is much slower 
than normal stomach digestion. 

Leube recommends the following as a nutrient injection : " Take 



BEVERAGES. 51 

about five ounces of finely-scraped meat ; chop it still finer, add to it 
one and a half ounce of finely-chopped pancreas free from fat, then 
add about three ounces of lukewarm water, and stir to the consistence 
of a thick pulp." 

An excellent substitute for the usual nutrient injections is defibrin- 
ated blood. This practice is elsewhere briefly alluded to in this work, 
but it is desirable to add further particulars. The blood must be de- 
fibrinated as it flows away, which may be done by stirring it with a 
bundle of twigs. Thus prepared, from four to six ounces should be 
thrown into the rectum twice a day. A single objection may be urged 
against this method : sometimes a foul-smelling and tenacious material 
coats the surface of the mucous membrane and prevents absorption. 
For this reason, and to promote a favorable disposition of the blood, 
the bowel should be irrigated with water once or twice a week to clear 
away any retained or adherent matters. If the rectum is irritable, a 
little laudanum may be added to each blood-enema. 

Supplementary Rectal Alimentation. — Under this designation, 
Dr. A. H. Smith of New York describes a method of rectal alimenta- 
tion with defibrinated blood, which seems in a high degree useful. He 
ascertained that " three to four ounces of blood administered at night 
would be so completely absorbed in the course of eight or ten hours 
that no trace of it could be found in the morning evacuation." To 
retain the blood fluid, it must be defibrinated at the moment it is drawn. 
In chronic cases three to six ounces may be thrown into the rectum 
morning and evening ; in acute cases every two to three hours. It may 
be used cold, but it is better to raise it to the temperature of the rec- 
tum. Constipation usually results, and in some instances the body 
exhales a rather fetid odor, and the stools are offensive. 

BEVERAGES. 

Coffee. — The seed of caffea Arabica ; cafe, Fr. ; Kaffee, Ger. 

Composition. — Coffee contains an alkaloid — caffeine — which is 
nearly, if not quite, identical with theine, a principle found in tea ; a 
volatile oil ; a form of tannic acid ; sugar, gum, etc. The tannic acid 
is that variety known as caffeo-tannic, or caffeic. 

The peculiar odor and flavor of roasted coffee are due to the caf- 
feic acid, which is, in part, converted into methylamine ; to the aro- 
matic oil ; doubtless, also, to the sugar, which is changed into caramel. 

Preparations. — Coffee is never used in the raw state as a bever- 
age. After roasting, it is made into an infusion or decoction. An 
infusion made at a low temperature, which should not exceed 200° 
Fahr., is better than a decoction. If the heat be too great, those aro- 
matic constituents which impart to coffee its special aroma are dissi- 
pated. Coffee is now usually prepared by the process of percolation. 



52 RESTORATIVE AGENTS. 

The best product is obtained by steeping the coffee for some time in 
hot water. Coffee can be " settled," or clarified, by the addition of 
some white of egg, or isinglass, or by pouring on from a height some 
cold water. 

Tea. — The Dried Leaves of Camellia Thea ; The, Fr. ; Thee, Ger. 

Composition. — The constituents of tea are very much the same as 
those of coffee : theine ; an aromatic oil ; sugar and gum, and a pecul- 
iar form of tannic acid. 

Preparations. — Tea is only used in the form of infusion. The 
character and quality of the beverage vary greatly with the kind of 
tea used in the preparation of the infusion. It will suffice to state that 
green tea is more astringent than the other varieties, partly because it 
contains more tannin, and partly because it is sophisticated to adapt 
it to a peculiar taste. 

Cocoa. — Obtained from the Seeds of Theobroma Cacao ; Cocoa, 
Fr. ; Kakao, Ger. 

Composition. — The active principle is theobromine, a substance 
which resembles the alkaloids of coffee and tea, except that it con- 
tains more nitrogen than theine and caffeine. Another important differ- 
ence between cacao and coffee and tea is the large amount of a peculiar 
fat (cacao-butter) contained in cocoa. There is also present a minute 
quantity of a volatile oil, on which depends, in part, the characteristic 
aroma. 

Actions and Uses. — The use of coffee and tea, or of a corresponding 
beverage, is almost universal among civilized nations. This fact is sup- 
posed to indicate that a need exists in the human constitution which these 
beverages supply. Such a view is hardly tenable, the highest physical 
and mental activity not being incompatible with entire abstinence from 
them. Under some circumstances, however, they are peculiarly grate- 
ful ; for example, to remove the sense of fatigue and hunger, and to 
allay the mental unrest produced by fatigue and anxiety. 

Coffee has a somewhat laxative action on most persons ; on the 
other hand, tea has astringent properties — especially that variety known 
as green tea. It has been affirmed and denied that coffee and tea lessen 
the rate of tissue metamorphosis, and consequently the excretion of 
urea. If these beverages check waste, they may be considered as in- 
direct nutrients. If used to excess as beverages, they derange the or- 
gans of digestion and excite functional disturbances of the nervous sys- 
tem — on the part of the digestive organs : acidity, flatulence, pyrosis, 
eructations, etc. ; on the part of the nervous system : headache, vertigo, 
tinnitus aurium, and confusion of mind. The evil results of habitual 
excess are best seen in sewing-women addicted to tea-tippling. It is 
not uncommon for these women to live upon tea and bread for long 
periods, resulting in their becoming excessively nervous and dyspeptic. 



BEVERAGES. 53 

The mucus of the stomach plays the part of a ferment ; the bread un- 
dergoes the acetic fermentation, and this process is facilitated by the 
presence of a quantity of a weak astringent solution. Disorders of 
digestion due to this cause can be removed by withdrawal of the offend- 
ing beverage. It is not less true that the after-dinner cup of coffee not 
unfrequently assists the digestion of a too elaborate dinner. Those ac- 
customed to the morning cup of coffee are apt to suffer from headache 
if deprived of their usual beverage, partly because it hastens the intes- 
tinal movements and assists the morning evacuation, and partly because 
it favors the stomach digestion if not taken in excess. 

A cup of strong coffee taken in the early morning is held to be 
prophylactic against malarial infection. Coffee produces wakefulness, 
and opposes opium narcosis ; bence strong black coffee is one of the 
means resorted to in the treatment of opium-poisoning. 

Cocoa, as already set forth, is more directly nutritious than coffee or 
tea, and, as it is rich in fatty matters, is much more difficult of diges- 
tion, so that many dyspeptics cannot use it at all. Cocoa is the most 
useful beverage in those conditions of the system requiring nutritious 
aliment, especially in phthisis and similar wasting diseases, and should 
constitute a part of the diet in these maladies unless it disagrees. 

Caffeine as a remedy will be considered in its appropriate place. 

Milk. — Regarded from all points of view, milk is the most impor- 
tant beverage. Enough has been said on the subject of milk as a food 
for invalids ; but something additional may be necessary on its dietetic 
position as an ordinary beverage. 

When coffee, tea, and cocoa disagree, milk may be adopted as the 
ordinary beverage, and usually with great advantage. For breakfast it 
may be drunk warm. Large draughts of iced milk, according to the 
American custom, are injurious when drunk at meals ; its temperature 
should not be lower than 60° Fahr. If a sense of weight and uneasi- 
ness follow its use, it will be better borne if diluted one-fourth to one- 
half with lime-water. If it be desired to improve its nutritive quali- 
ties, cream to one-fourth or to one-half may be added. In the indigestion 
of the obese, or in the case of those who suffer from hepatic disorders, 
the milk should be skimmed. A very valuable nutrient, but which is, 
unfortunately, not very digestible, is chocolate made with milk and 
cream. Such an aliment is especially suited to invalids with wasting 
diseases, but who yet retain the power to digest fats. 

Some find it impossible to drink milk, because it induces "bilious- 
ness." In this case skimmed milk should be used. Generally the indi' 
gestion called " biliousness " means errors of diet in other directions, 
so that regulation of the food suffices to prevent this form of indis- 
position. 



51 RESTORATIVE AGENTS. 

Authorities referred to in this section : 

Ballot. On the Food of Infants, etc., Medical Times and Gazette, vol. i., 1870, p. 331. 

Banting. Letter on Corpulence, pamphlet. 

Brinton. On Food and Digestion, London, 1861, pp. 485. 

Cyr, Dr. Jules. Traite de Alimentation, Paris, 1869, pp. 5Y5. 

Donkin, Dr. Arthur Scott. On a Purely Milk-Diet in the Treatment of Diabetes 
Mellitus, Bright'.? Disease, Disease of the Supra-renal Capsules, Fatty Degeneration, etc., 
Lancet, vol. ii., 1869, and vol. i., 1870. 

Flint, Dr. Austin, Jr. Physiology of Man, Alimentation, Digestion, Absorption, 
New York, 1867. 

Fonssagrives, J. B. Higiene Alimcntaire, deuxieme edition, Paris, 1867, pp. 670. 

Jones, Dr. Joseph. IT. 8. Sanitary Commission, Memoirs Medical, p. 469, et seq. 

Lethebt, Dr. H. On Food, second edition, New York, 1872, pp. 255. 

Lebert, Dr. Hermann. Ueber Milch- und Molken-Kuren, Berlin, 1869. 

Ibid. The Medical Times and Gazette, vol. ii., 1870, p. 201. 

Mitchell, Dr. S. Weir. On the Use of Skimmed-Milk as an Exclusive Diet in Dis- 
ease, Philadelphia Medical Times. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittelehre, Berlin, 1870, p. 676. 

Parkes, Dr. E. A. A Manual of Practical Hygiene, second edition, London, 1866, 
pp. 624. 

Pereira, Dr. Jonathan. A Treatise on Food and Diet, London, 1843, pp. £42. 

Richter, Dr. H. E. Bericht iiber Milch-, Molkcn-, und Kumys-Kuren, Schmidt's 
Jahrbucher der gesammien Medicin, vol. cxlviii., p. 201. 

Smith, Dr. Edward. Foods, New York, 1873 (International Scientific Series), pp. 
4S5. 

Tardieu. Dictionnaire d'Hygiene Publique, tome xi., Article " Lait." 

Trousseau. Clinique Medicate, vol. ii., p. 695. 

For some new matter in the preceding section, I am indebted to the 
following works : 

Bennet, Dr. James Henry. Nutrition in Health and Disease, second edition, Phila- 
delphia, Lindsay & Blakiston, 1876. 

Chambers, Dr. Thomas King. A Manual of Diet in Health and Disease, Philadel- 
phia, Henry C. Lea, 1875. 

Jacobi, Dr. A. and Dr. Mary Putnam. Infant Diet, New York, G. P. Putnam's Sons, 
1876. 

Smith, Dr. A. H. Archives of Medicine, New York, G. P. Putnam & Sons, 1879. 
Vol. I., No. 2., p. 113. 

"WATER. 

Water. — Aqua, water ; eau, Fr. ; Wasser, Ger. ; aqua destillata, 
distilled water — water freed from its organic and inorganic impurities 
by distillation. 

Aqua Fluvialis. — River-water. 

Aqua Fontana. — Well or spring water. 

It is not my purpose to consider fully the subject of the actions and 
uses of mineral waters. There are special treatises on the subject of 
mineral springs, to which I beg to refer the reader. Water as a remedial 
agent, when employed in internal maladies, and as a means of applying 



HYDROTHERAPY. 55 

heat and cold externally, are the only departments of the subject com- 
ing within the scope of this work. 

Physiological Effects of Water — internal. — It need hardly be 
stated that water is an essential constituent of the tissues. 

A certain quantity of water or fluid aliment is necessary to the 
digestive process. An excessive quantity impairs digestion, by so far 
diluting the gastric juice as to render it incapable of dissolving the 
foods. Pepsin — the digestive ferment — is also weakened by too great 
fluidity of the stomach contents. The free use of cold drinks — ices and 
icod-water — seriously disorders digestion by suspending the action of 
the pepsin, by diminishing the blood-supply needed by the stomach in 
its condition of functional activity, and no doubt also by depressing the 
nerves of the organs of digestion. To this state, induced by the free 
use of very cold drinks during meals, or during the time of digestion, 
has been applied the term " ice-water dyspepsia" a very common 
malady in the United States. 

A glass of cold water in the morning before breakfast will in many 
persons cause a satisfactory evacuation of the bowels. The activity of 
the water is increased by the addition to it of a teaspoonful of common 
salt. 

Although water is essential to the constitution of the fluids and 
solids of the body, there is no doubt that large and frequent draughts 
cf water may prove injurious by too great increase in the fluidity of the 
blood, and a consequent damage to the red corpuscles. 

The free use of water promotes nutritive changes, and causes in some 
subjects a decided increase in the formation and deposition of fat. The 
presence of water is essential, of course, to the metamorphosis of tissue, 
whether physiological or pathological. The efficacy of mineral waters 
is in part due to the quantit}' of water taken, besides the mineral con- 
stituents. Water may be taken with the view to cause increased excre- 
tion of certain substances. As a large part of that taken passes out by 
the kidneys, the functional activity of these organs is promoted by free 
drinking. With the water also passes out an increased amount of urea, 
chloride of sodium, and phosphoric acid, the product of the more rapid 
tissue-changes which ensue. The increased elimination of chloride ot 
sodium does not continue, however. 

Water is also excreted by the skin, and free water-drinking pro- 
motes the cutaneous transpiration, especially when its action is aided 
by external warmth. The vapor of water also passes out abundantly in 
the breath. 

Physiological Effects of Water — external. — The influence of 
temperature must necessarily be considered in connection with the 
effects of water when applied externally. 

Effects of Cold Water. — When an extremity — for example, the 
hand — is immersed in cold water, the temperature of the other hand 



56 RESTORATIVE AGENTS. 

also falls. Cold water abstracts the heat of the body, at least of its 
superficial surface, and affects the condition of the internal organs 
through the nervous system. It is through an influence transmitted 
from the peripheral distribution of the nerves of the hand to the centre, 
and thence reflected to corresponding anatomical nervous connections 
on the other side, that the fall of temperature in the one hand is due 
when the other hand is immersed in water. We have a right to assume, 
therefore, that, when cold water is applied to the whole surface of the 
body, changes of temperature take place within. Indeed, it has been 
shown experimentally by Brown-Sequard, that ice applied to the lumbar 
region causes a contraction of the arterioles of the kidneys, and conse- 
quent diminished blood-supply to these organs. 

When a cold bath is entered, a marked sense of chilliness is expe- 
rienced, the skin become's pale and is roughened by the erection of the 
hair-follicles (cutis anserina), the lips are blue, the breath has a spas- 
modic and catching character, and the pulse is quickened. The tem- 
perature of the surface is lowered, for the blood accumulates in internal 
organs, and the nerves of the skin are depressed. To the change in the 
conditions of the blood-supply, and the impression of the cold on the 
peripheral expansion of the nervous system, are due the coldness of the 
surface, the sobbing respiration, and the feeling of discomfort and de- 
pression. If the temperature of the water be not too low, and if the 
bodily vigor be sufficient to withstand the shock, the condition known 
as " reaction " speedily ensues. The coldness and depression are suc- 
ceeded by warmth and a feeling of exhilaration ; the pulse quickens, and 
the respiration becomes easy and unembarrassed ; and the muscular 
strength is increased. If, however, the body be immersed for too long a 
period, the condition of reaction is supplanted by coldness, depression, 
weakened pulse, and muscular debilit}\ This result is largely due to the 
continuous abstraction of heat, to the accumulation of blood in the great 
venous trunks, and the consequent interference with the metamorphosis 
of tissue. If healthy reaction comes on after bathing, the effects are 
those to which we apply the term tonic. The circulation is invigorated, 
tissue-changes take place more rapidly, and the products of increased 
tissue-metamorphosis are found in the urine. With the increased 
activity of the function of assimilation, the appetite and digestive power 
are improved, and the body gains in weight. 

Effects of Warm Water. — The degree of effect which is produced 
by the immersion of the body in warm water is influenced by the tem- 
perature ; but the quality of the effect is the same at all degrees from 
tepid to hot. The sense of warmth is at first grateful to the feel- 
ings : the skin becomes red from the increased activity of its vessels ; 
the pulse quickens in beats, but diminishes in tension; the respiration 
is more frequent; precordial oppression is experienced; an unpleasant 
sense of distention is felt in the head, and giddiness, faintness, and 



HYDROTHERAPY. 57 

muscular languor, finally, are produced, if immersion be prolonged or the 
temperature be too high. The pulmonary and cutaneous transpiration 
are increased by the warm bath ; the temperature of the body rises, and 
a condition is established by a hot bath, similar to the febrile state. 
Rapid disintegration of tissue ensues, the waste products escape chiefly 
by the skin and pulmonary mucous membrane, and decided loss of 
weight results. 

Modes of applying Water. — The water of a cold bath should have 
a temperature of 40° to 60° Fahr. If employed for its tonic action, the 
patient should not remain in it longer than the period of complete re- 
action. The tepid bath has a temperature of from 85° to 95° and the 
warm bath from 95° to 100° Fahr., and the hot bath from 100° to 106° 
Fahr. The duration of the stay in these will depend on the purpose to 
be accomplished, whether mere excitation of the circulation in the skin, 
diaphoresis, or muscular relaxation. In directing the warm and hot 
bath, it should not be forgotten that a diseased state of the cerebral ar- 
teries is a contraindication to their use. 

The vapor of water in the form of the Russian bath, steam-bath, or 
warm or hot wet-packing, may be used to accomplish the same objects as 
those obtained by the warm or hot bath. Without entering unduly into 
the details, it will suffice to state that the Russian bath consists in the 
exposure of the body in suitable apartments to the vapor of hot water, 
at a temperature gradually increased from 95° to 110° Fahr. The bath 
should not, under ordinary circumstances, exceed fifteen minutes in dura- 
tion. In order to overcome the relaxing and debilitating effects of the 
bath, the patient should either entert a cold bath or have cold water 
dashed over his body. This expedient, conjoined with friction of the 
surface, increases materially the good effects of the Russian bath. In 
the absence of special arrangements for giving the Russian bath, simple 
means will suffice. The patient may sit upon a low stool with a blanket 
Dinned about his neck, and under this the vapor of water may be con- 
ducted. Or, if confined to bed, the patient may be placed on a gum- 
cloth, and the blanket may be elevated above him by hoops, arranged 
transversely, under which the vapor of water may be conveyed from an 
ordinary tea-kettle. Fresh lime is sometimes used to generate hot vapor. 
The patient is placed on a low stool and surrounded by a blanket. Some 
pieces of freshly-burned lime are then dropped into a vessel of water 
placed under the blanket. The slacking of the lime causes great heat, 
and the consequent generation of a considerable quantity of watery 
vapor, which also carries up with it minute particles of lime. This pro- 
ceeding is said to be especially efficacious in membranous croup and 
diphtheria. 

Enveloping the body in cloths wrung out in hot water, or wrapping 
in a sheet which has been wrung out in hot water, and then covering 
with blankets, is a mode of applying moist heat wdiich may be advanta- 



58 RESTORATIVE AGENTS. 

geously used. To various parts of the body, under the designation of 
" fomentations," warm and hot water applications are constantly used 
in domestic practice. 

The Wet-Pack. — This efficient means of producing the good effects 
of cold-water applications consists in wrapping the body in a linen 
sheet wrung out in cold water. The appliances are these : An ordinary 
single bedstead : a hard mattress covered with several thicknesses of 
blankets or comforters ; a linen sheet. The sheet is dipped in cold 
water, and, when thoroughly wrung out, is laid smoothly on the bed. 
The patient reclines on the sheet, his head supported by a pillow. One 
side of the sheet at a time is then drawn over the patient's body and 
neatly tucked under the opposite side, the feet and legs being lifted up 
and the sheet made to entirely envelop them. Some blankets or comfort- 
ers are now closely applied around the body of the patient. There is at 
first experienced a disagreeable sense of chilliness and discomfort, which 
is soon succeeded by a delightful glow. When reaction is fully estab- 
lished, the wet-pack should be removed, and the body be well rubbed 
with dry towels. The duration of this application should be from fif- 
teen minutes to an hour. When active diaphoresis is the object to be 
accomplished, the patient must be well enveloped in blankets, and con- 
tinue in the bath for the longest period mentioned above. 

The Rubbing Wet-Pack. — This is a convenient mode of taking the 
morning bath as a hygienic measure, and also of procuring more speed- 
ily some of the good effects of the wet-pack as applied above. It con- 
sists in enveloping the body with a sheet dipped in cold water, and 
rubbing vigorously with the sheet to induce reaction quickly. The 
patient stands up during the application, and an attendant rubs those 
parts inaccessible to the patient. When the sheet is removed the skin 
is dried by the vigorous application of coarse towels, and the patient 
immediately puts on his clothing. 

When it is not advisable to apply the wet-pack to the whole body, 
or when local diseases require limited application of the wet-pack, the 
sheet may be wrapped around the trunk only, or be confined to the re- 
gion of the affected organ. In cases of extreme debility, or in very sus- 
ceptible persons, the sheet may for the first applications be wrung out 
in tepid water, and subsequently the temperature of the water be low- 
ered to that of the air (40° to 70° Fahr.). 

The Douche. — This consists in the impact against the body of a 
column of water from a height. No greater height than ten feet, and a 
column not larger than four inches, will be proper or safe under any cir- 
cumstances. A hose attached to a water-pipe, the supply being regu- 
lated by a stopcock, is a convenient mode of using the douche. In 
domestic practice a large pitcher or water-bucket, if provided with a 
suitable spout, may be utilized for this purpose. The douche may be 
either cold, tepid, or hot ; it may have a direction descending, ascend- 



HYDROTHERAPY. 59 

ing, verticil], liorizont.il, or oblique; and the effect may be regulated by 
the height from which the water is projected, the size of the stream and 
the force with which it is thrown against the part. As the effect of the 
douche is very great when the water is cold, when the volume of the 
stream is large and when it is thrown with force, it is obvious that care 
must be used in directing it against the head, the chest, and the abdo- 
men. As a rule it is too violent a measure to be employed in weak and 
susceptible subjects about the trunk, but it may be used freely, of course, 
on the extremities. 

The Hip or Sitz JBath. — As regards temperature, this bath may be 
cold, tepid, warm, or hot, according to the indications requiring it. The 
apparatus for administering it consists of a tin or wooden tub of suffi- 
cient capacity to contain water enough to cover the hips and lower part 
of the abdomen when the patient sits down in it. The tub should have 
a raised back to support the patient, and should be sufficiently elevated 
above the floor, so that the feet may rest comfortably when the patient 
sits down in the water. In the absence of a special arrangement of this 
kind, any ordinary washing-tub will suffice. The duration of the hip or 
sitz bath will be from five to thirty minutes. 

Besides these, various local baths, cold, warm, or hot, under various 
designations, are used in medical practice, e. g., foot, hand, elbow, and 
head bath. The effects of these differ in no wise from the baths already 
described, except in degree. 

Therapy. — The applications of water in the treatment of disease are 
numerous and important. 

In tonsillitis, diphtheria, and croup, ice held in the mouth and al- 
lowed to come in contact with the fauces is extremely serviceable. The 
wet pack to the neck gives great relief in the same diseases. The mode 
of applying it is as follows : A napkin is wrung out in iced or cold water 
and wrapped around the neck; and over this is put a dry towel or nap- 
kin to prevent evaporation, and also the wetting of the patient's clothes. 
In sp>asmodic croup {laryngismus stridulus) the application of iced- 
water in this way will frequently very quickly stop the crowing inspi- 
ration and allay the distress of breathing. A cold douche will effect the 
same result, but this is an unnecessarily harsh remedy in these cases. 
Sometimes hot applications are more efficacious, when the napkin or 
towel may be wrung out in w r ater as hot ascanbe borne. Cold affusion, 
or, better, sponging of the body with cold water, is an excellent means 
of preventing laryngismus stridulus when it arises from cold. 

Habitual constipation may sometimes be overcome by a glass of 
oold water taken before breakfast. Hemorrhoids that bleed, especially 
when attended by constipation, are improved by a daily rectal injection 
of cold water. When cold or warm water injections are used to cause 
an evacuation, it must be remembered that, usually in adults, a large 
amount of water is necessary — about one quart. A small quantity of 



60 RESTORATIVE AGENTS. 

ieed-water may be effective, for in this case the impression of the cold 
on the nerves of the rectum excites a reflex action of the whole intestinal 
canal. 

Pure water or distilled water is an effective diuretic, especially 
adapted to the relief of acute desquamative nephritis. The action con- 
sists in free discharge of the surplus water by the kidneys, and the con- 
sequent washing out of the tubules obstructed by the cast-off epithelium 
and tube-casts. Large draughts of water, as has already been stated, 
carry out from the kidneys the products of retrograde metamorphosis, 
and hence the action is diuretic in the widest sense. The efficiency of 
many infusions, decoctions, and ptisans, employed in dropsies, is largely 
due to the amount of water ingested. The internal use of water in kid- 
ney-diseases may be supplemented by hot fomentations to the lumbar 
region. (See article Digitalis.) As irritation of the skin of the back 
has been shown experimentally to influence the cahbre of the renal ar- 
terioles, there is sufficient warrant for the practice of applying these 
fomentations to the lumbar region, when the functional activity of the 
kidneys is insufficient. 

When renal disease is so far advanced that the elimination of urea 
is seriously hindered, and stupor, somnolence, muscular tioitchings, and 
even convulsions occur, great relief is obtained by exciting free action 
of the skin by means of the vapor-bath or hot wet-pack, the patient 
being well enveloped in blankets to favor powerful diaphoresis. The 
Turkish bath is very serviceable to restore the suppleness of joints and 
muscles after an attack of acute rheumatism, and chronic muscular 
rheumatism is benefited by the same means. No permanent good result 
can be expected from these baths in chronic rheumatic arthritis. 

As a means of causing elimination of mineral poisons, baths are 
useful. Lead, mercurial, and paludal cachexias, are relieved by the 
Turkish bath and the wet-pack, and, although these means are insuffi- 
cient of themselves to effect a cure, they aid very materially the action 
of other remedies. Increased metamorphosis of tissue and increased 
excretion, are it will be remembered, constant effects of these baths. 
If the wet-packing be used, free diaphoresis should be encouraged, by 
abundant covering and by large draughts of water. 

One of the most important recent improvements in therapeutics is 
the treatment of fevers by cold baths. This is an old expedient, it is 
true, but it is only within a few years that the treatment of fevers by 
baths has been placed within the domain of strictly scientific investiga- 
tion. Various means of applying water in fevers have been resorted 
to — cold affusion, cold baths, cold wet-pack, ice-bags, etc. Cold affusion 
consists simply in dashing successive buckets of water over the patient, 
stripped and lying on a mattress protected by a gum-cloth. The apph- 
cations are continued until the temperature is reduced. This is a crude 
method, and wears an aspect of harshness which may prevent its effi- 



HYDROTHERAPY. 61 

cient use in private practice. The cold bath is more serviceable and is 
free from the objectionable features of cold affusion. As practised ac- 
cording to the method of Ziemssen, it is grateful to the patient, produces 
no shock, and exerts a powerful influence over the temperature. The 
fever-patient is put into a bath about the normal temperature of the 
body (98 a Fahr.), and the water is cooled, by the addition of ice, to 80° 
Fahr., to 60° Fahr., or even to 40° Fahr., according to the effect pro- 
duced on the temperature, which, for this purpose, should be taken in 
the rectum. When a positive reduction of the fever-heat has occurred, 
at the expiration of five minutes to half an hour usually, or longer if 
necessary, the patient should be wiped dry, placed in bed, and covered 
with blankets. The bath may be used according to the nature of the 
case, from two to six times each day, but less frequently if the duration 
be longer than a half-hour. The appliances for administering baths to 
fever-patients are : A strong sheet for lifting the patient from the bed 
into the bath-tub ; a bath-tub provided with an exit-pipe for drawing 
otf the surplus water ; a thermometer for ascertaining the temperature 
of the bath, and a clinical thermometer for noting the variations of 
temperature of the patient. Hospitals should be provided with such 
arrangements as have been made at the London Hospital for the use of 
baths in fever. These consist of a small ward with two beds ; a bath- 
tub supplied with hot and cold water ; a tank, with which the cold-water 
pipe communicates, in which ice may be put if necessary; and a large 
waste-pipe for disposing quickly of the surplus water. 

In the absence of suitable bath appliances, the temperature of fever 
patients may be reduced by simpler methods. Iced-water may be in- 
jected into the rectum frequently ; cloths dipped in iced-water may be 
applied to the trunk, and Chapman's ice-bags may be put to the spine. 
More suitable than these methods is the wet-packing. Although the 
wet-packing is not so effective as the bath, it is a very powerful means 
of reducing fever-heat, and it has the merit of simplicity of application, 
so that in every household it may be used if necessary. The patient 
may be put into the wet-pack several times each day, according to the 
state of the temperature, and may remain in it from five minutes to an 
hour. 

If, after the application of water by any of the modes above men- 
tioned, the circulation becomes feeble, the extremities cold, and the lips 
blue, stimulants should be administered and bottles of hot water applied 
to the feet. The good effects of baths are these : the temperature de- 
clines, the pulse falls and becomes soft and compressible, the skin grows 
moist, and the patient feels refreshed. The repetition of the bath or of 
the application of cold water will be determined by the rise of tempera- 
ture, and of the pulse. Some practitioners employ them regularly, as 
for example Von Ziemssen and Immerman, who administer them at 6 A. 
M., 1 to 3 p. Jr., and 7 p. M. ; but others — and this the author thinks the 



62 RESTORATIVE AGENTS. 

better plan — give them more or less frequently according to the range 
of temperature. Not only is the mortality of typhoid greatly less under 
hydrotherapy than under any other method of treatment, but the compli- 
cations which belong to it — except hemorrhage — occur less frequently. 

The most conspicuous triumph of the water-treatment of the pyrex- 
ial state is seen in the management of hyperpyrexia, a condition of 
things in which a sudden and rapid rise of temperature takes place, 
the range being in extreme cases from 105° to 112° Fahr. It is now 
perfectly well known that any temperature above 108° Fahr. is almost 
necessarily a fatal sign. This condition of hyperpyrexia occurs some- 
times in acute rheumatism, delirium tremens, fevers, etc., and has here- 
tofore not been amenable to treatment. A fatal result in these cases 
may be averted by cold baths, the temperature of the bath being rap- 
idly reduced from 96° to about 60° Fahr., by the addition of ice. It 
is sometimes necessary in these cases to prolong the stay in the bath 
to two or three hours, but it must not be forgotten that no absolute rule 
can be made, the state of the patient's pulse, respiration and tempera- 
ture being the guide not only as to the temperature of the bath, but 
the duration of the stay in it. 

Typho-malarial fever is best treated by the same means ; but ma- 
larial fevers are, of course, so unquestionably remediable by quinine 
that any other treatment is a waste of time. Baths are, however, ex- 
tremely grateful in the pyrexial stage of malarial fevers. 

Cold baths are of equal utility in scarlatina. In mild and uncom- 
plicated cases of this disease, no remedies are required, and simple 
sponging of the body, followed by inunctions of oil, is all that is required. 
When, however, the temperature rises to 104°, 105°, 106° Fahr., and 
higher, and there is delirium or stupor, the rash being dark and indis- 
tinct, and the urine scant} 7 , the cold wet-pack will often render most 
signal service. The rash will reappear and become vividly red ; the 
pulse, respiration, and temperature, will decline. The cold wet-pack to 
the neck, and frequent gargling of the throat with warm water, relieve 
the sore-throat, and are really more effective than the caustic applica- 
tions so commonly resorted to. When the urine becomes scanty and 
highly albuminous, hot fomentations to the lumbar region, with or with- 
out addition of medicaments, are often very serviceable. The vapor- 
bath, or the warm wet-packing, by determining free diaphoresis, relieves 
the brain when convulsions are threatened, or have actually occurred, 
from urasmia. 

Other eruptive diseases, measles, small-pox, cerebrospinal menin- 
gitis, are advantageously treated in the same way. 

Constitutional syphilis is very much ameliorated, and the cure by 
specific treatment hastened, by a course of Turkish baths, or wet-pack- 
ing. Three baths should be taken each week. If the wet -packing be 
used, the patient should remain in it until free diaphoresis is produced. 






HYDROTHERAPY. C3 

The wet-packing is very efficacious in acute rheumatism, but the 
prejudices of the patient, and of the patient's friends, often interfere to 
prevent its use. If there be much pain and soreness, the front of the 
body may be packed, and the inflamed joints may be separately swathed, 
but, whenever practicable, the packing should include the whole bod}*. 
A vapor- bath is often very serviceable. A vinegar vapor-bath has been 
used, it is said, with great advantage. This application may be readily 
made in the following way: Some bricks are previously heated; the 
bedclothes are elevated above tne patient by hoops transversely placed ; 
and vinegar is poured over the heated bricks, which have been laid un- 
der the bedclothes. The perspiration which follows these baths should 
be wiped off, the skin quickly sponged with tepid water, and then dried 
with a soft towel. Great relief is experienced from these applications ; 
the joints are less tender, the fever declines, and the acid perspirations 
are diminished. Chronic rheumatism, if chiefly muscular, and if changes 
have not occurred in the joints, which are simply stiff, and chronic gout, 
are much benefited by the Turkish bath. 

In .acute cerebral congestion, the cold douche may be applied to the 
head, while the feet are immersed in warm water. A piece of ice, held 
against the nape of the neck, acts powerfully in the same way. The 
alternate application of ice and hot water is often more effective than 
ice alone. The author has seen these alternate applications of ice and 
hot water have an excellent effect in the stupor of opium -narcosis, of 
uraemia, and in carbonic-acid poisoning, occurring under various con- 
ditions. 

In inflammatory affections of the meninges, and in meningeal haem- 
orrhage, a bag or bladder of pounded ice has the sanction of universal use. 
The author believes that these applications are often made without due 
discrimination in cerebral haemorrhage and other allied states. When 
the face is pale, the surface cool, and the circulation depressed, cold 
applications to the head are harmful. Ice to the head, and frictions of 
the surface with ice, are very serviceable in sunstroke or thermic fever, 
when the surface is hot, the pupils contracted, and the pulse full and 
bounding. The cold wet-packing gives great relief under the same cir- 
cumstances, but, when the symptoms of depression exist, these cold 
applications are hazardous. Usually, however, in thermic fever, the 
range of temperature is very high, and the most important indication is 
to abstract the heat, which can be best accomplished by application of 
ice or the cold wet-pack, or the cold bath. The results of the practice 
are in accordance with this theory, for these applications have been most 
successful in restoring patients in imminent danger of death. When, 
in delirium tremens, the head is hot, the conjunctivae injected, the face 
flushed, and the pulse strong, an ice-bag to the head, or cold affusion, 
or a mild douche, will assist in quieting the patient, and favor the pro- 
duction of sleep ; but these measures will do mischief when consider- 



64 RESTORATIVE AGENTS. 

able depression of the bodily powers exists, and they are of doubtful 
utility in any case affording evidences of atheroma of the cerebral aite- 
ries, or of cardiac disease. Cold affusion to the head and spine, and cold 
baths, are among the most important means of relief in chorea. "Wake- 
fulness in children and adults may be often overcome, and quiet sleep 
insured, by a tepid bath taken just before retiring ; but, when the head 
is hot, the eyes brilliant, and the circulation active, cold should be ap- 
plied to the head, while the body is immersed in the tepid bath. 

The shower-bath, the douche, and cold affusion, were formerly much 
used to calm the violence of acute mania and maniacal delirium. The 
great depression of the powers of life which the douche and the shower- 
bath have caused in some cases, and the fatal results which have occurred 
during their administration, have led to their disuse by many alienist 
physicians. By others, they are held to be extremely serviceable in 
appropriate cases. Bucknill and Tuke advise the occasional use of the 
shower-bath in the excitement of intercurrent mania and monomania, 
and a daily shower-bath in melancholia. They advise, further, that the 
shower-bath should, in the first-named group of cases, be used no longer 
than three minutes, and in melancholia from fifteen to thirty seconds, 
the patient being dried while standing in a pan of hot water. The 
same authors prescribe a warm bath of thirty minutes, at 95° Fahr., for 
the excitement and sleeplessness of various forms of insanity, and they 
affirm that its " tranquillizing effect is often wonderful." The simulta- 
neous use of cold affusion to the head and the warm bath has been 
warmly advocated by M. Brierre de Boismont, and is decidedly approved 
by Bucknill and Tuke, who advise that the duration of the bath should 
not exceed one hour. The wet-pack is an exceedingly valuable remedy 
in the excitement of acute mania, but this measure should not be allowed 
to degenerate into a means of restraint merely. It should be applied in 
the mode already described, and the patient should continue in it until 
free diaphoresis is established. 

In infantile convulsions great benefit is derived from the general 
warm bath combined with cold affusion, or an ice-bag, to the head. 
Hysterical convulsions are quickly relieved in the same way, and the 
hysterical state is much improved by a daily shower-bath. 

Water, cold and warm, in the state of vapor, as ice, has been largely 
applied in the treatment of tetanus and hydrophobia, but without good 
results beyond the merest temporary assuagement of the patient's suf- 
ferings. 

Lesions of the Spinal 3Ieninges and of the Cord, corresponding 
pathologically to those of the brain, are remediable by similar means as 
respects hydrotherapy. The author has seen remarkable improvement 
follow a hot douche to the spine in a case of paraplegia of syphilitic ori- 
gin. The backache so common in women, and frequently due to anse- 
mia of the cord, may be much relieved by a sponge dipped in hot water 



HYDROTHERAPY. 65 

and passed ov r er the spine. The hot douche to the spine is often more 
decidedly serviceable in these distressing cases. 

Alterations of sensibility, analgesia, anesthesia, hyperalgesia, hy- 
peresthesia, are often relieved by hydrotherapy — by the wet-pack, by 
ice, by local hot and cold effusion. Neuralgic affections, especially 
sciatica, are benefited greatly by the wet-pack. Paralyzed parts that 
have become cold and that waste, and that are undergoing other nu- 
tritive changes, are improved in condition by douches, by wet-pack- 
ing, and other methods of the water-cure. 

In inflammatory affections within the chest, wet-packing is very 
useful. As a rule, a hot wet-pack gives more relief than a cold one, 
but the feelings of the patient are a proper guide. In acute pleuritis a 
cold wet-pack applied to the side unquestionably diminishes the pain, 
and no doubt relieves the inflammation. In pneumonia hot wet-packs 
are more suitable. When the organs within the chest are inflamed, it 
is good practice to wrap the whole chest tightly in a pack to limit the 
motion of the chest-walls. The method of proceeding is as follows: 
Wring out in cold or hot water a large towel, fold it and place over the 
affected side or part ; have in readiness a bandage or long towel suffi- 
cient to encircle the chest, and confine the wet-pack by pinning as 
tightly as possible around the chest the bandage or towel. Spongio- 
piline is an excellent material for making these hot or cold applications. 
The same exjaedients — the application of cold and the tight bandage — 
are of great utility in pulmonary hemorrhage, but a more decided 
effect, by means of ice-bags to the chest and back, may be procured in 
this condition of things. 

Cold and hot applications have unquestionable value in inflamma- 
tory affections of the abdominal organs. The author has seen excellent 
results from the application of an ice-bag over the swelling in cases of 
typhlitis and perityphlitis. Peritonitis is similarly treated with advan- 
tage. When the inflammation is recent, the abdomen may be covered 
with an ice-bag of sufficient size. It has been shown that not only may 
the local symptoms of inflammation be abated in this way, but the 
general temperature of the body be thus reduced. It is proper, in mak- 
ing these cold applications, to interpose a napkin or towel between them 
and the skin. 

Pounded ice is an excellent application to strangulated hernia to 
favor reduction, and this has often been sufficient when the taxis failed. 
Hemorrhoids that are much swollen and painful, or that bleed, are 
much improved by applications of ice. Bubo and swelled testicle are 
greatly benefited, and the pain attendant on them relieved, by ice. 

Cold to the abdomen in the form of ice or cold water, and ice-water 
thrown into the uterus or ice introduced into the cavity of the womb, 
are measures of great utility in uterine hemorrhage, whether from 
threatened abortion or post partum. 
6 



6G RESTORATIVE AGENTS. 

Hot-water injections, or the hot douche, is one of the most effective 
measures to be used in chronic metritis. A large quantity of water and 
frequent applications are needed to procure the best results. Not less 
than a quart of water as hot as can be borne, and three applications each 
day, are necessary. A Davidson's syringe, a vessel containing hot 
water, and a suitable vessel to receive the w r ater as it flows away, are 
the materials needed for the vaginal douche. The first effect of this is 
to increase the blood-supply, but a marked degree of pallor of the mu- 
cous membrane follows, the opposite effect to that caused by cold 
water. When there is great relaxation of the vaginal passage and 
the uterus is large and spongy, the cold douche is more serviceable. 
Excellent results are sometimes obtained by the alternate use of the 
hot and cold douche. 

The applications of water in surgical practice are numerous and im- 
portant. As a dressing for wounds, contusions, and, inflamed parts, it 
is in universal use. The author is convinced that the cold-water treat- 
ment of wounds is often overdone, the circulation in the wounded part 
being too much depressed, whence repair is slow or sloughing is in- 
duced. The hot-water dressing, or the immersion of the affected part 
in hot water (95° to 100° Fahr.), as proposed and practised by Prof. F. H. 
Hamilton, of New York, is a method which promises most successful 
results : 

"The phenomena usually observed in cases of recent lacerated or 
incised wounds, when submerged, are a sense of comfort, yet not abso- 
lute relief from pain ; on the second or third day the parts adjacent are 
swollen but not much reddened ; the integument generally assumes a 
white and sodden appearance, and with only slight tenderness. On the 
fifth, sixth, or seventh day, the swelling is greater than usually ac- 
companies other plans of treatment ; and, with the inexperienced, is 
likely to excite alarm, but it is found not to be attended with increased 
tenderness, and it pits under pressure, showing that it is a condition of 
oedema chiefly. At this time the granulations are generally covered 
with lymph, or some exudate of a whitish color, and which might easily 
be mistaken for a diphtheritic deposit. At the end of fourteen days or 
thereabouts (the period at which, in most cases, we substitute fomen- 
tation for submersion) the limb is still cedematous, the granulations are 
abundant, sometimes presenting a fresh red appearance, and at others 
covered with the white exudate." 

Prof. Hamilton further remarks : " No treatment hitherto adopted, 
under our observation, has been attended with equally favorable re- 
sults. Under this plan the area of acute inflammation is exceedingly 
limited; erysipelatous inflammation has been uniformly arrested or re- 
strained when it has actually commenced, and it has never originated 
after submersion ; gangrene has in no instance extended beyond the 
parts originally injured, and, when progressing, it has in most cases 



HEAT. 07 

been speedily arrested (in gangrene, hot water or water at a tempera- 
ture of from 100° to 110° Fahr. is to be preferred). Septicaemia and 
pyaemia have not ensued in any case in which submersion has been prac- 
tised from the first day of the accident. Purulent infiltrations and con- 
secutive abscesses have been infrequent, and always limited to the 
neighborhood of the parts injured, and of small extent. Traumatic 
fever, usually present after grave accidents, when other plans of treat- 
ment have been pursued, as early as the third or fourth day, has seldom 
been present when this plan has been adopted, and in no case has the 
fever been intense or alarming." 

For the immersion of hand, foot, arm, and leg, Hamilton has con- 
structed bath-tubs of peculiar shape. He advises this method of treat- 
ment in contused or lacerated wounds of the extremities. Simple 
incised wounds and amputations are unsuited to this plan of treat- 
ment. 

I subjoin the titles of some of the most recent and important con- 
tributions to our knowledge of the actions and uses of water. It ^s 
proper to add that I have also consulted the works of the followers of 
Priessnitz, but they are singularly deficient in accurate and scientific 
knowledge. 

Brand, Dr. Ernst. Die Heilung des Typhus, mil eincm Anhang: Anweisung fur 
die Krankenwarter bet Behandlung dcs Tophus mil Badern, Berlin, 1868, A. Hirsch- 
wald. 

Braun, Dr. Jtlius. Systematisches Lchrbueh dcr Balneotherapy, dritte umgearbei- 
tete Auflage, Berlin, 1873, pp. 71-1. 

Fox, Dr. Wilson. Observations on the Treatment of Hyperpyrexia, London Lancet, 
vol. ii., 1871, p. 231, el scq. 

Hamilton, Dr. Frank H. The Medical Record, New York, vol. he., Hay 15, 
1S74. 

JL'rgensen, Dr. Theodor. Die Kbrpcrwurme dcs gesunden Memchen (Sludien), Leip- 
zig, 1873, p. 28, et seq. 

Liedermeister, Prof. Dr. Carl. Bcobachtungen mid Versuche uber die Anwendung 
dee kalten Wassers bie fiebcrhaftcn Krankhaften, Leipzig, 1808, pp. 480. 

Imn. Ziemsseris Cyclopaedia, American edition, vol. i., p. 206, et seq. 

Ibid. Handbuch der Pathologie und Therapie des Fiebcrs, Leipzig, 1875, p. 598, el 
seq. 

Yalentiner, Dr. Tii. Handbuch der allgemeinen und specicllen Balneothcrapie, George 
Reimer, 1S73, pp. 850. 

HEAT. 

Physiological Action's. — It is difficult to assign beat to its proper 
position in a systematic classification. As a stimulant to the vital pro- 
cesses, it pertains to the class of agents promoting constructive meta- 
morphosis; but, in its influence on the intercbanges of repair and waste, 
the action quickly passes into the stage of waste. As its therapeutical 



68 RESTORATIVE AGENTS. 

employment is almost entirely confined to the range of constructive 
metamorphosis, it seems more appropriate to embrace it in this division 
of the subject. 

The normal heat-production of the body varies singularly little in 
health. Every considerable rise of temperature above, every consider- 
able fall below, the normal of 98.5° Fahr., indicates the existence of dis- 
ease. The various external causes of disturbance of the heat-producing 
function of the body do not, in health, affect the normal standard, 
because of the existence of a regulating apparatus. Every one is 
familiar with the fact that the human body can be exposed, without 
risk, to a temperature much above its own standard, provided the heat- 
regulating function is in a condition of health}' activity. If, however, 
the transmutation of heat into another mode of motion cannot be effect- 
ed, then the complexus of morbid actions, called fever, is at once estab- 
lished. Every increment of heat added to the body, unable to transmute 
it into another mode of motion, adds to the existing temperature. 

Very important alterations take place in a body, the seat of a febrile 
process. Increased waste, the result of more rapid oxidation, takes 
place ; the excretion of urea, and, according to some authorities, of car- 
bonic acid, is increased; and those important and wide-spread lesions, 
entitled parenchymatous degenerations, occur in various organs of the 
body. 

Modes of applying Heat. — 1. Solar Heat. — The rays of the sun may 
be applied directly to the whole surface, or to any part of the body. 
When the whole body is exposed to the rays of the summer sun, the 
head and face ought to be protected. The skin becomes warmer, the 
capillaries dilate, an erythematous blush appears, and the amount 
of blood in the peripheral vessels is increased above the normal. The 
rays of the sun in midsummer, ranging from 95° Fahr. to 125° Fahr., 
produce considerable burning heat, and cause a superficial inflammation 
of the skin, which is followed by desquamation. When the heat is less 
powerful, only an agreeable sensation of warmth may be experienced. 
Decidedly caustic effects may be produced by the concentration of the 
solar rays on a small spot of integument by a double-convex lens — a 
burning-glass, it has been called. This may be utilized as a means of 
counter-irritation. 

Besides the heat, the solar rays contain chemical or actinic rays ; 
and hence it is not improbable that chemical effects of a very important 
kind, or, it may be, catalytic effects, follow the application of the 
solar rays to a considerable portion of the body. Further, it cannot 
be doubted that excitation of the cutaneous nerves by the heat and 
chemical rays of the sun must affect the condition of the brain and 
spinal cord, and,, through the sympathetic system, the nutrition of the 
body. 






HEAT. C9 

2. Artificial Heat. — There are various modes of applying artificial 
heat. It may be dry or moist. 

.Moist Heat. — The Vapor-Bath. — It consists simply in the appli- 
cation of the vapor of water to the surface of the body. Sufficient atten- 
tion, for the limits of this work, has been bestowed on this subject in 
the article on " Hydrotherapy." 

Dry Heat. — To the general surface of the body dry heat may be 
applied by simply raising the temperature of the air of the apartment, 
the body being uncovered. Local application of dry heat may be made 
to any part by means of woolen cloth, earthen plates, sad-irons, bags of 
salt, bricks, etc., heated to the proper temperature. The effects of these 
applications depend largely on the amount of heat contained in these 
objects. They produce at first the sensation of warmth, redness of the 
skin, and may cause vesication, or deep-seated burning and destruction 
of the tissues. 

The "Turkish Bath. — This differs from the Russian bath, in that it 
consists of dry air without the presence of the vapor of water. The 
human body can exist in dry air at a very high temperature, without 
injury, for a short period, provided it is in a state of health. The tem- 
perature of the air of the Turkish bath ranges from 95° Fahr. to 160° 
Fahr., but the highest point is attained at the conclusion of the process. 
There are usually three apartments, so that the patient passes from one 
grade of temperature to another, and thus avoids the unpleasant, even 
dangerous, effects of high heat suddenly applied. When the tempera- 
ture reaches 110° Fahr., already some distress is experienced. As the 
heat increases, the breathing becomes short, hurried, and labored ; the 
action of the heart is tumultuous ; an unpleasant sensation of heat and 
irritation, with itching, is felt over the whole body; the head has a 
feeling of fullness, with constriction of the forehead and ringing in 
the ears ; perspiration soon begins, and, when the temperature reaches 
the highest point, is very profuse. 

It is obvious that a decided impression is made on the organism by 
a Turkish bath. The first effect of the heat is on the sensory nerves — 
the impression of warmth. The peripheral vessels dilate, and, of course, 
admit into them a larger amount of blood, with the effect to diminish 
the amount of blood in the internal organs. The temperature of the 
blood rises with the increase of heat ; the action of the heart corre- 
sponds, and a state of fever would be quickly induced if the excess of 
heat were not at once disposed of by the perspiration, in which, accord- 
ing to the doctrine of the correlation of forces, it disappears as motion. 
The circulation being more rapid, and the peripheral vessels containing 
more blood, a more active metamorphosis of tissue probably takes place. 
Elimination is more active through the skin, but is less active through 
the intestinal canal and the kidneys. The acidity of the urine is in- 



70 RESTORATIVE AGENTS. 

creased, and the water and salts are relatively diminished. Remotely, 
the tension of the vascular system falls, absorption becomes more active, 
the muscular tonus declines, and the sensibility of the nervous system 
and of the special senses is lowered. 

Therapy. — "Warm applications possess a high degree of utility in 
the various painful and inflammatory affections of the abdominal 
organs. Acute peritonitis, local or general, is probably more frequently 
benefited by applications of ice. As a rule, the feelings of the patient 
furnish the guide to the selection of the temperature. In the absence 
of any specific indication from the feelings of the patient, the following- 
rule may be adhered to : If the case be one of pain without fever or 
inflammation, warm or hot applications ; if inflammatory, cold. Those 
materials which retain heat and moisture longest are to be preferred ; 
for example, the material known as spongio-piline, poultices of flaxseed- 
meal, flannels wrung out in hot water, and covered with oiled-silk, etc. 
When the weight of the application is objected to, a light material, like 
a bag of hops dipped in hot water, may be applied. In affections of the 
pelvic viscera, the same modes of application can be resorted to, under 
the same conditions. 

Heat, especially dry heat, is a very important remedy in sudden 
and alarming depression of the vital p>owers, with feebleness of the 
heart's action and coldness of the surface. Active haemorrhage, of 
course, contraindicates its employment. Feeble infants, born at term 
or prematurely, are often saved by the application of dry heat — the 
highest temperature which can be borne without blistering being 
. necessary. The methodus medendi is simple enough : the heating of 
the blood in the superficies of the body increases the movement of 
both heart and lungs. High heat, especially if long continued, is 
decidedly contraindicated in cases of fatt}* and fibroid degeneration 
of the heart, in cases of carditis, considerable obstruction of the ori- 
fices, etc. 

Hot-air baths, and hot applications of any kind, may be dangerous 
in old subjects, and in those persons of middle age who present the evi- 
dences of degenerated vessels. Not unfrequently, attacks of migraine, 
cases of ordinary neuralgia of the fifth, tic-douloureux of mild form, etc., 
are relieved by hot, dry applications made over the course and pe- 
ripheral distribution of the affected nerves. Stuptor and coma, due to 
uraimia, or to narcotic medicines, may be relieved by dry heat applied 
to the neck. The alternate use of cold and heat is generally more effi- 
cient. In neuralgia of the larger nerves, dry heat is palliative. In 
irritable spine, the so-called spinal irritation, dry heat is an efficient 
remedy. In these cases solar heat is especially serviceable — the sun's 
rays falling on the spine, or, what is better, the rays concentrated by a 
burning-glass on various points on the spine. 



AIR. 71 

Probably the most generally useful application of dry heat is in the 
treatment of chronic rheumatism and in general dropsy. In the treat- 
ment of these maladies, elimination is the object to be accomplished; 
in the one case, of certain excrementitious substances, notably of uric 
acid ; and in the other, of water by the skin. 

The Turkish bath has an unquestionably good effect in constitu- 
tional syphilis. Here there are two objects to be accomplished— to 
promote the action of the mercurial medicines and of the ptisans, and 
to secure elimination through the shin. In the same way the Turkish 
hath is highly useful in plumbic, mercurial, and paludal cachexias. 
Our French colleagues maintain the superior value of sulphur-vapor 
baths in the cachexias produced by the mineral poisons. 

AIR. 

The Atmosphere. — As a therapeutical agent, only, is air to be con- 
sidered here. Nevertheless, various hygienical relations of the subject 
are also therapeutical, and must therefore be included. 

Composition. — The atmosphere is a mechanical mixture of oxygen, 
nitrogen, and we should also add carbonic acid, and the vapor of wa- 
ter. In round numbers there are 21 parts of oxygen, 79 parts of nit- 
rogen by volume, and .033 per cent, of carbonic acid. The essential 
constituents — oxygen and nitrogen — are quite uniform in proportion 
in all parts of the world, but the carbonic acid and vapor of water vary 
considerably, owing to local causes. Contrary to the generally re- 
ceived opinions, the quantity of carbonic acid is greater at the tops of 
the highest mountains than on the plains, and the oxygen less. The 
amount of moisture is determined chiefly by temperature, and when 
the air can contain no more, it is said to be saturated. A trace of am- 
monia also is present in the air, and a minute quantity of active oxy- 
gen or ozone. 

When a beam of electric light is made to traverse the atmosphere, 
minute particles, previously invisible to the eye, and some even extra- 
microscopic, come into view. The lowest forms of life — microzymes, 
bacteria, etc. — are found in great numbers ; in cities, particles of car- 
bon, lime and other earthy matters, fibres of cotton and woolen cloth, 
leather, ordure of animals, etc. ; in the country, pollen of plants, and 
particles of vegetable tissues ; in hospital wards, pus-cells and other 
matters derived from the persons, wounds and discharges, bedding, 
and utensils of the sick. We owe our present knowledge of these ac- 
cidental constituents of the air chiefly to the researches of Professor 
Tyndall. 

Various gaseous matters are also accidentally present in the air, 
varying in different localities in consequence of local telluric condi- 



72 RESTORATIVE AGEXTS. 

tions, and certain trades and manufactures. As respects the first, there 
are carbonic acid and carbonic oxide, sulphuretted and phosphuretted 
compounds of hydrogen, marsh miasm, etc. Under the second may 
be included sewer-gas, gaseous emanations from decomposing animal 
matter, from chemical works of various kinds, etc. 

Physiological Effects. — 1. Pure Air. When air is breathed in 
the process of respiration, the oxygen passes into the blood, and car- 
bonic acid, the vapor of water, a trace of ammonia, and some organic 
matter, pass out. The blood which leaves the lungs is changed in 
color, from the dark, purplish hue of venous, to the scarlet of arterial 
blood ; it has gained oxygen, and lost carbonic acid and water. The 
cause of the diffusion of gases in the lungs is chiefly the difference in 
tension of the gases in the blood and in the atmosphere — the tension 
becoming equal in the process of respiration (Hermann). 

In the tissues where oxidation-processes are taking place, there is, 
also, a respiration process going on, consisting in the formation and 
excretion of carbonic acid. 

2. Impure Air. — So essential to life is the supply of oxygen to 
warm-blooded animals, that they cannot be deprived of it, even for a 
very short time, without danger to life. As pure oxygen cannot be 
inhaled for any considerable period without injury, admixture with 
some " indifferent gas " becomes necessary. Thus nitrogen is utilized 
in the formation of atmospheric air. The other indifferent gases are 
hydrogen and light carburetted hydrogen, or marsh gas : when mixed 
with oxygen, they can be breathed with impunity ; when inhaled 
alone, they cause dyspnoea and asphyxia. 

Certain other gases are entitled " irrespirable," because, owing to 
the chemical actions instantaneously set up, they cannot be inhaled. 
Some of these irrespirable gases are acid — as carbonic, muriatic, hypo- 
nitrous, sulphurous, etc. ; others form acids by combination with oxy- 
gen, as nitric oxide, etc. ; others are alkaline, as ammonia ; others es- 
tablish an ozonizing action, as chlorine, bromine, etc. 

Other gases are comprehended in a group as " poisonous," of which 
there are three classes. The first class contains those which seize and 
combine with the oxygen of the blood, decomposing haemoglobin. 
They are hence called " reducing gases," of which sulphuretted hydro- 
gen, phosphuretted hydrogen, etc., are examples. The gases of the 
second class displace the oxygen and enter into combination with the 
haemoglobin. Carbonic oxide and nitric oxide are examples of these 
displacing gases. The third class contains the gases used for the pro- 
duction of anaesthesia. 

In the process of respiration, the air loses its oxygen, nitrogen is 
relatively partly increased, carbonic acid accumulates, and certain ill- 
defined " organic matters" appear. This vitiated air exerts a most in- 
jurious influence, and soon becomes unfit to sustain life. The amount 



AIR. 73 

of carbonic acid which can be breathed without injury has not been 
definitely ascertained, but is greater than is commonly supposed. 
According to Pettenkofer and Voit, 10 per 1000 volumes produce no 
discomfort. When, in a crowded apartment, headache, vertigo, and 
feeble circulation are apparently caused by the quantity of carbonic 
acid present, these results are in part due to the lessened supply of 
oxygen, and to the action of nitrogen and organic matters. 

The foul air from cesspools and sewers affects the health of man 
in two modes : by the direct action of the gases of decomposition, and 
indirectly by acting as carriers of the germs of disease. As respects 
the former, its injurious influence has probably been exaggerated ; for 
the original observation of Parent-Duchatelet, that workmen engaged 
in cleaning the sewers of Paris suffered from no diseases due to their 
occupation, has been abundantly confirmed in the subsequent experi- 
ence of the French officials. It is probable, also, that certain persons 
possess a high degree of susceptibility to the action of sewer-gas, and 
are affected by comparatively minute quantities. When sewer-gas is 
admitted to private houses, and is breathed by such susceptible per- 
sons, they decline in health, become easily fatigued, lose appetite and 
suffer with nausea and diarrhoea, waste, and have an earthy, sallow 
complexion. If the gas is more concentrated, they experience more 
acute symptoms, and have attacks of a choleriform character. Of 
course asphyxia is produced when the gas is so concentrated as to dis- 
place oxygen entirely, as is the case sometimes in old drains and privy 
vaults, the air of which, as is well known, may extinguish life speed- 

Sewer-gas, examined microscopically, is found to be loaded with 
minute particles, the lowest forms of life, etc., and hence it is in a high 
degree probable that the germs of fevers, dysentery, cholera, diph- 
theria, etc., may in a similar manner be conveyed by it. 

Effects of Compressed Air. — Our knowledge of this subject is de- 
rived in part from observations made on workmen engaged in under- 
ground avocations requiring them to labor under greatly increased 
barometric pressure ; in part from observations made on patients un- 
dergoing the compressed-air treatment; and in part from experimental 
researches on animals. 

Not to enter too far into details out of place here, it suffices to state 
that the inhalation of compressed air lessens the respiratory move- 
ments and the number of heart-beats, and increases the arterial tension. 
The effect of this change in the conditions of the circulation is to 
diminish the amount of blood in the veins and auricles, and to increase 
it relatively in the ventricles (Sanderson). On ophthalmoscopic exam- 
ination of the fundus ocuH it has been ascertained (Yon Vivenot) that 
the blood-vessels of the retina diminished in size with the increase in 
the pressure. Compressed air does not appear to influence materially 



74 RESTORATIVE AGEXTS. 

the production of carbonic acid, but it does the absorption of oxygen 
(Von Liebig). The changes induced in the phenomena of life under 
high barometric pressure have been carefully studied by Paul Bert, 
who seems to have established that the evil effects of such pressure are 
largely due to the formation of bubbles of gas in the blood. He finds 
that nitrogen is dissolved in the blood during the time of high pres- 
sure, and returns to the gaseous state when the pressure ceases. He 
further ascertained that the bubbles of gas obstructed the circulation 
at various points, especially in the lumbar portion of the spinal cord, 
causing paraplegia. When the accumulation of gas was sufficient in 
amount, the pulmonary circulation was obstructed and the heart para- 
lyzed by the sudden distension. 

Aie as a Therapeutical Agent. — As a general rule, the sick re- 
quire more air-space than the healthy. The mere cubic dimensions 
are much less important than the amount of oxygen available for res- 
piration ; but as the sick are more readily affected by draughts than 
the healthy, it follows that the sick require more cubic space, and less 
frequent renewal of the air. It seems generally conceded that 2,000 
cubic feet of air-space' per patient is necessary in hospitals and in the 
sick-room to supply the needed amount of oxygen, although a less 
space may be better if provided with the means of frequent changes 
of air without sudden variations of temperature and strong currents. 
A large cubic space of stagnant air will be inadequate to the require- 
ments of the sick. Even when so large an amount of air as 3,700 cu- 
bic feet per hour for each patient has been supplied to a hospital ward, 
the air in it has had a distinctly " stuffy " and offensive smell. Every- 
body is familiar with the fact that the sick and wounded do better in 
tents and in the open air, than in the best constructed military hos- 
pitals. 

If, as has been affirmed by the highest sanitary authorities, 1,000 
cubic feet of air-space is necessary to a healthy adult, it is clear that 
the sick require not less than we have named, 2,000 ; for the renewal 
of the air in the case of the latter must be less rapid. As the means 
for the renewal of the air in the sick-chamber in private houses consist 
of doors, windows, and fireplaces — or natural ventilation — the supply 
to the patient is variable. To insure the best results under these cir- 
cumstances, the bed should be so placed as to be without stagnant 
corners and recesses, and yet not within the range of currents or 
draughts. When the air is still, movements may be produced by 
burning a lamp in the chimney. In cold weather the fire in the fire- 
place induces a strong upward current in the chimney, the air coming 
from all the crevices. It would be quite beyond the subject-matter 
of this treatise to consider the various mechanical contrivances which 
have been proposed, and are now used, to secure proper ventilation in 
public institutions and hospitals ; but it may be useful to mention 



AIR. 75 

those devices by which, natural ventilation in the sick-chamber may be 
promoted. 

Where there are opposite windows, cross-draughts may be preven- 
ted by the following expedients : 1, by giving an upward slope to the 
window, so that the current of fresh air is deflected toward the ceiling; 
2, by having some of the window-panes doubled, the outer one having 
a space at the bottom of the pane, and the inner one at the top ; 3, by 
fastening a block to the upper sash which prevents closing. If there 
are windows at one side only, the room may be efficiently ventilated 
by vertical tubes carried up the walls from some distance (a few feet) 
and communicating with the external air. 

In the fevers, exanthemata, diphtheria, dysentery, etc., an abun- 
dant supply of air is a measure of the highest utility. The result in a 
doubtful case may be determined by the amount of oxygen received 
by the patient. Furthermore, free admission and exit of air is the 
most efficient means of destroying disease-germs, and their retention 
in a stagnant atmosphere intensifies their virulence. In febrile affect- 
ions, the apprehension of " taking cold " may be allayed by the assur- 
ance that the condition of fever is preventive. Draughts, however, 
should be avoided in measles and in all affections of the breathing or- 
gans. 

There are two conditions in diseases of the respiratory organs, in 
which an abundant supply of air is essential : inflammatory affections 
in which the breathing space is encroached upon so that the oxygena- 
tion of the blood is hindered ; and chronic maladies, as emphysema, 
asthma, etc., in which labored breathing is a consequence in part of 
mechanical defects. Considerable diminution in the supply of air has 
a powerful influence in the production of consumption. The statistics 
on this point collected by the English Sanitary Commission seem con- 
clusive, and since their recommendation of increased cubic air-space in 
the barracks, the number of cases of phthisis has materially dimin- 
ished. In the treatment of this disease, a suitable supply of air be- 
comes even more imperative. The subjects of this disease should oc- 
cupy apartments, whenever practicable, provided with ample windows 
and fireplace, and frequent renewal of the air day and night should be 
secured by some of the contrivances now used for this purpose and al- 
ready referred to. Whenever, by reason of fever or debility, exercise 
in the open air cannnot be taken, the patient, suitably clad and pro- 
tected in severe weather, may sit' in an apartment with all the win- 
dows and doors open, a part of each day. 

Maladies characterized by a deficiency in the oxidation processes 
throughout the body, require increased supply of air under all the cir- 
cumstances of life. The most important of these are diabetes, gout, 
rheumatism, obesity, excess in the production of lithiates, etc. The 
good effects of open-air exercise in these disorders result chiefly from 



76 RESTORATIVE AGENTS. 

the increased consumption of oxygen. Anosmia, chlorosis, convales- 
cence from acute diseases, and chronic toasting maladies, also require 
increased consumption of air : the oxygen is even more important than 
the iron which is given so profusely in these cases ; indeed, without 
additional oxygen, the assimilation of the iron can hardly be accom- 
plished. 

Therapeutical Applications op Compressed Air are effected 
by two modes : by placing the patient in a chamber in which the air 
has been condensed by an air-pumping engine ; and by having the pa- 
tient breathe, through a mask closely fitting the mouth and nose, air 
compressed in a portable reservoir. The latter method only is ordin- 
arily available. Without entering into minute details, it will suffice 
to say that the former method consists of an air-tight chamber eight 
feet high and seven feet wide, in which three patients can sit comfort- 
ably. The air is compressed gradually to one and a half atmospheres 
— a pressure of twenty-two pounds to the square inch — and the patient 
remains in the chamber about an hour and a half. One of the first 
and most complete arrangements of this kind was erected under the 
supervision of Dr. Liebig (not the chemist) at Reichenhall, Bavaria ; 
and he has since communicated the results of his large experience to 
the Aerztliches Intelligenz-Blatt of Munich. The portable apparatus 
now most used is that of Waldenburg (der transportable pneumatische 
Apparat). This consists of an outer cylinder containing some water, 
and an inverted inner cylinder containing air, which fits in to the outer 
one. Obviously the air within may be condensed or rarefied by low- 
ering or raising the inner cylinder, which is easily effected by applying 
weights. A mercurial manometer indicates the degree of condensa- 
tion, and a water-gauge the height of the water. "With the air-cham- 
ber a flexible tube, having an oro-nasal mask attached, communicates. 
With this apparatus the patient breathes either condensed or rarefied 
air at the will of the operator. The author has had arranged for his 
own use a pneumatic apparatus which can be employed for inhalation 
of compressed or rarefied air, and for the atomization of liquids. It 
is only available in cities where a sufficient water-pressure can be ob- 
tained. It consists of a brass cylinder strongly made, and containing 
at the top a stop-cock and pipe for the admission of water, and at the 
bottom a stop-cock for drawing off the water. At the top, also, there 
is a stop-cock and pipe for the attachment of the flexible tube and oro- 
nasal mask, and a gauge for registering the pressure. The admission 
of water effects the compression of the air ; its removal — all the stop- 
cocks being closed — effects the rarefaction. Precisely the same results 
can be attained as in the more complicated arrangement of Walden- 
burg. Furthermore, the author's apparatus can be employed as an 
atomizer, using compressed air or steam. 

The applications of compressed air are numerous and important. 



AIR. 77 

The results are chemical and mechanical. The chemical effects are 
due to the increased supply of oxygen ; the mechanical, to the distri- 
bution of the blood-pressure. In anaemia, chlorosis, amenorrhoea, in 
the neuralgia}, especially of the fifth nerve, headache, epistaxis, in 
gout, diabetes, obesity, etc., very excellent results are obtained by 
the use of compressed air — which means the increased consumption of 
oxygen. To achieve all that is possible to effect in these cases, the 
treatment must be continued for a considerable time. 

It is, however, in certain cardiac and pulmonary affections that the 
pneumatic treatment is especially commended. Acute catarrh, nasal, 
faucial, bronchial, if early applied ; chronic bronchitis, with or with- 
out emphysema, capillary bronchitis, atelectasis, asthma, dilatation of 
the right cavities, and fullness of the venous with ischaemia of the ar- 
terial system, are conditions in which the compressed air is signally 
beneficial. Probably in emphysema, more than in any other malady, 
has the relief afforded by this treatment been most conspicuous ; for 
this is a disease which has hitherto offered few results to therapeutical 
skill. " Die Exspiration in verdiinnter Luft ist das specifische mecha- 
nische Antidot des Emphysems," is the dogmatic statement of Walden- 
burg — " Expiration into rarefied air is the specific mechanical antidote 
to the emphysematous affections." 

The rules for the inspiration and expiration of rarefied and con- 
densed air respectively, may be formulated as follows : 

As inspiration of condensed air increases the intra-thoracic air-pres- 
sure, it impedes the flow of blood to the right auricle, and lessens 
somewhat the pulse rate, and is accordingly indicated in cases of dysp- 
noea having a mechanical origin, in incipient phthisis, in asthma, bron- 
chitis, and in insufficiency of the mitral. 

As inspiration of rarefied air has the opposite effects to those of 
condensed air, its use is indicated in the few cases in which increased 
inspiratory power is desirable, as in contracted thorax, the result of 
effusion. 

Expiration into condensed air increases the expiratory power when 
deficient, and expiration into rarefied air is indicated in emphysema 
and chronic bronchitis. 

Authorities referred to : 

Bert, Dr. Paul. Comptes Rendus, vol. lxxiii., quoted in London Medical Record, vol. 
i., p. 375. 

Burden-Sanderson, Dr. J. The Salt and Compressed Air Cure of Reichenhall, The 
Practitioner, vol. i., p. 218. 

Von Liebig, Dr. Aerztlisches Intelligenz-Blall. London Medical Record, vol. xi., p. 
473. 

Von Vivenot, Dr. Rudolf. Virchow's Archiv, Band xxxiv., p. 515. 

Waldenburg, Dr. Die pneumatische Behandlung der Respirations- und Circulations- 
Krankheiten, etc. Hirschwald, Berlin, 1875. 



78 RESTORATIVE AGEXTS. 



MASSAGE. 



Definition. — The term massage is probably derived from the 
Arab word mass, which signifies "to knead." The French word mas- 
sage is equivalent to the term shampooing, and is applied to a process 
of rubbing, friction, and percussion of the body. Masseur is a male 
rubber, and masseuse a female rubber — that is, persons who make a 
business of massage. 

Method. — Massage by friction consists in rubbing, rolling under 
the fingers, and gently pinching the skin, and rubbing, tapping, knead- 
ing, and exercising the muscles and joints. Beginning at an extrem- 
ity, the foot for example, the skin is taken up between the thumb and 
fingers and rolled and pressed ; then the muscular masses are well 
grasped, rolled and pressed and kneaded, and rapidly tapped a quick 
succession of light blows ; and then each articulation is in turn put 
through all of its motions. Even the muscles of the neck and the in- 
terossei may be subjected to the same treatment, with a little address 
and painstaking. In fact, no part of the body should be omitted ex- 
cept the face. 

Massage by percussion alone consists in applying to various parts 
of the body a very rapid succession of short blows, not forcible enough 
to cause pain. The blows or taps may be made with a wooden spatula 
with the fingers as arranged for percussion, or with the lateral margin 
of the hand fully extended. 

Dr. Mortimer Granville has accomplished notable results in the 
treatment of neuralgia by rapid percussion over the trajectory of the 
nerves affected. He has devised a small instrument for this purpose, 
called percutier. The curative results of this delicate percussion are 
attributed by Granville to a modification in the nerve molecules. 

Physiological Effects. — The good effects of massage are popu- 
larly ascribed to electrical or supernatural agency. That electrical 
currents are induced by massage is true, but the curative effects are 
attributable to other agencies. 

The effects of massage are : 1, local ; 2, systemic. 

1. The masseur or rubber puts forth more or less muscular power, 
which, at the points of contact or friction, developes or is transformed 
into another mode of motion — heat. The action thus induced in the 
constituent tissues of the parts operated on, also serves to elevate the 
temperature. The vessels dilate and an increased quantity of blood 
enters them, and the motion of the blood-current is accelerated. The 
immediate effect of these changes is to promote the nutritive energy 
of the tissues subjected to friction. This result is seen in the im- 
proved color, warmth, and volume of the parts. 

2. A general rise of temperature, equal in most instances to one 
degree, has been observed to take place quite uniformly (Mitchell). 



MASSAGE. 79 

The body increases in weight ; all the organic functions are performed 
with more energy, and power is gained in every way. Massage in its 
several forms exercises peculiar effects on the nervous system, which 
should not be overlooked. When an inflamed part which can be ma- 
nipulated, a joint for example, is rubbed with excessive gentleness, the 
sensibility, Avhich was at first so acute that every touch gave pain, 
rapidly subsides, until, after an hour of friction, it may be handled 
with some roughness without evoking painful sensations. When the 
local condition is that of pain merely, it is remarkable how the acutest 
suffering is alleviated by persistent friction of a gentle kind. Again, 
the state of spasm of a muscle is relieved and relaxation induced by 
persevering rubbing of the affected muscle. Results such as these are 
explicable only on the theory that the gentle titillation of the cuta- 
neous branches of the nerves (end-organs) has so far lowered their irri- 
tability that they cease to receive and transmit painful impressions. 
The rapid and long-continued transference to the centres of conscious 
impressions of the gentle titillation of the end-oi*gans allays the irri- 
tability of the centre, so that if pain be transmitted, it excites no re- 
action, and therefore is not realized. 

Theeapy. — Obstinate wakefulness and nocturnal restlessness may 
often be relieved by massage of pressure or percussion. Very gentle 
and long-continued friction of the extremities, especially of the lower 
extremities, is necessary, or corresponding tapping. Simple headache, 
even severe paroxysms of neuralgia, and the spasms of tic douloureux, 
are often most surprisingly relieved by, at first, exceedingly deHcate 
frictions of the end-organs of the fifth — the skin of the face, forehead, 
neck, and the scalp — and subsequently stronger rubbing of the same 
parts. The same method has been effective in hemicrania, migraine, 
and spinal pain (Westerlund, Graham, Putnam, and others). Next to 
electricity, massage is the most useful remedy we possess in the treat- 
ment of infantile paralysis and other wasting palsies, after the acute 
symptoms have subsided. In hemiplegia and other forms of paralysis 
due -to intra-cranial lesions, the indications for the treatment by mas- 
sage are a lowered state of the nutrition of the paralyzed parts, cold- 
ness and blueness of the skin", wasting and contracted muscles, ulcer- 
ations, etc. In progressive muscular atrophy, much more may be ac- 
complished by persistent frictions and kneadings of the wasting muscles. 
The treatment should be begun early, and the first indications — pain, 
fibrillary trembling, weakness, etc. — require the massage, without wait- 
ing for obvious wasting. Of course, any treatment is useless when the 
wasting has proceeded so far that no muscular elements remain. 

Probably massage has accomplished more conspicuously good re- 
sults in chronic joint affections, synovitis, contractions and deformities 
and thickening from inflammatory deposits (Berghmann and Helle- 
day, Billroth, Mosengeil, and others). It is in this class of cases that 



80 



RESTORATIVE AGENTS. 



healers, natural bone-setters, and other empirics sometimes achieve 
surprising success in the face of failures by regular surgeons. The 
author therefore especially urges on young surgeons and physicians the 
extraordinary utility of massage in this group of cases, and the great 
results which can be achieved by it, when sections of muscles, tendons, 
and cicatrices may appear to be imperatively demanded. In many 
cases patient and long-continued use of the method may be required. 

In the hands of "Weir Mitchell, massage has proved of surprising 
benefit in cases of the so-called spinal irritation, with its protean 
manifestations in the nervous, muscular, digestive, and sexual systems. 
He uses it as a means of promoting the nutrition of the body generally, 
and of the muscular system particularly, while he maintains the body 
in a condition of nearly absolute rest. 

As the results obtained have been surprisingly great, it were better 
to indicate with some particularity the kind of cases to which massage 
seems best adapted, and we can do no better than employ the graphic 
language of Mitchell : " It includes that large group of women, espe- 
cially, said to have nervous exhaustion, or who are described as having 
spinal irritation, if that be the prominent symptom. To it I must add 
cases in which, besides wasting and anaemia, emotional manifestations 
predominate, and which are then called hysterical, whether or not they 
exhibit ovarian or uterine disorders. Nothing is more common in prac- 
tice than to see a young woman who falls below the health-standard, 
loses color and plumpness, is tired all the time, by-and-by has a tender 
spine, and soon or late enacts the whole varied drama of hysteria. . . . 
But no matter how it comes about, the woman grows pale and thin, 
eats little, or, if she eats, does not profit by it. Everything wearies 
her — to sew, to write, to read, to walk — and by-and-by the sofa or the 
bed is her only comfort." 

" In the treatment of these massage plays an important part. Rest, 
electrical excitation and exercise of the muscular system, systematic 
feeding, are employed in conjunction with massage." 

How far the results in the treatment by massage are affected by 
psychical impression has not been ascertained. The separation of 
these patients from home influences and associations, the confinement 
to bed, and the novel treatment, combine to affect the imagination 
profoundly, and to arouse hope and expectation to the highest point. 
In the class of cases described by Mitchell, these mental influences 
are powerful factors both in causing and curing morbid mental states. 
In illustration may be quoted Davy's celebrated case of paralysis cured 
by the mere application of the thermometer, and the remarkable re- 
coveries which occurred under the religious ministrations and prayers 
of Prince Hohenlohe. 

The extraordinary effects produced by the application of certain met- 
als in hysterical subjects (Burq's Metallotherapy) may also be quoted 



DIGESTION-FERMENTS. 81 

in illustration. The results obtained by Charcot from metallotherapy 
have been even more remarkable than the cures effected by Mitchell 
with massage. 

Authorities referred to : 

Berghman and Helleday. Ford. Med. Ark., vol. i., No. 7, 1873. Schmidts Jahr- 
oiicher, vol. clxvi., p. 158. 

Fate, Dr. L. Ibid. 

Graham, Dr. Douglas. Boston Medical and Surgical Journal, xciv., 6, p. 150. 

LeBlond, Dr. N. A. Manual de Gymnastique, etc., Paris, 1877, p. 228, el seq. 

Mitchell, Dr. S. Weir. Fat and Blood, J. B. Lippincott & Co., Philadelphia, 1877. 

Piorry, Dr. Dictionnaire des Sciences Medicates, vol. xxxi., art. Massage. 

Putnam, Dr. James. The Boston MeJical and Surgical Journal. 

Trousseau et Pidoux. Traite de Therap. et de Mat. Med., vol. ii., p. 91. 

Westerlusd, Dr. Schmidts Jahrbiicher, vol. clxvi., p. 158, op. cit. 



DIGESTION-FERMENTS. 

Pepsin. — Pepsina vel pepsinum / pepsina porci ; pepsine,¥r.', Ver- 
dauungsstoff, Ger. 

Definition. — A ferment obtained from the mucous membrane of 
the stomach of the pig. There are two processes worthy of mention 
for obtaining the ferment : Scheffer's, and Prof. Lionel S. Beale's. By 
Scheffer's process the mucous membrane is digested in a solution of muri- 
atic acid, and the pepsin precipitated with chloride of sodium. Beale 
directs that the mucous membrane be first cleansed and then scraped 
strongly with an ivory knife so as to remove the contents of the gastric 
glands. The pepsin is contained in the very viscid mucus which is thus 
removed. When spread on clean glass in a very thin layer, it is dried 
at a temperature not to exceed 100° Fahr.; and in the vapor of hot 
water or over sulphuric acid. 

Preparations. — Pepsina saccharata, dose 5 to 20 grains. Vinum 
pepsina?, dose 3 ss — 3 j. Glyceritum pepsinoe, dose 3 ss — 3 j. The 
wine of pepsin is an unscientific preparation, and should not be pre- 
scribed. Boudault's, really Corvisart's compound nutritive powder, con- 
sisting of pepsin, starch, and lactic acid, is an exceedingly uncertain 
preparation, and is often totally inert. Only those preparations of pep- 
sin should be used, made by the processes above described, especially 
those of E. Scheffer, of Louisville, Kv. The saccharated pepsin and the 
glycerole are practically unchangeable. 

Ingluvin. — This is a preparation from the gizzard of the domestic 
chicken — ventriculus callosus gallinaceus. Dose, gr. v. — 3j. 

Ingluvin has the remarkable property of arresting certain kinds of 
vomiting — notably the vomiting of pregnancy. It is a stomachic tonic, 
and relieves indigestion, flatulence, and dyspepsia. 

The author's experience is confirmatory of the statements which 
have been put forth regarding the exceptional power of this agent to 
7 



\ 



g2 RESTORATIVE AGENTS. 

arrest the vomiting of pregnancy. It can be administered in inflam- 
matory conditions of the mucous membrane, as it has no irritant effect. 
Under ordinary circumstances, and when the object of its administra- 
tion is to promote the digestive function, it should be administered 
after meals. When the object is to arrest the vomiting of pregnancy, 
it should be given before meals. 

Pancreatine. Pancreatic Emulsion. Liquor Pancreaticus. 
Pancreatine is the ferment of the pancreas. Under the name pan- 
creatic emulsion it has long been used as a means of promoting intes- 
tinal digestion, especially the digestion of the fats. The most ef- 
fective preparation is liquor pancreaticus, obtained by digesting 
minutely divided fresh pancreas with a weak alcoholic solution. As 
too much alcohol injures the ferment, and too little will fail to pre- 
vent decomposition, it is a nice point to determine the amount 
most suitable. Five per cent, of alcohol is probably a near ap- 
proximation to the proper amount. Pancreatine differs from pepsin 
in that its action is promoted by an alkaline condition, and destroyed 
by strong acidity. In the presence of an alkali it has the power to 
convert proteids into peptones, to emulsionize fats, etc. As acids de- 
stroy pancreatine, it follows that the liquor pancreaticus should not 
be given while stomach digestion is going on, but when the chyme 
has entered the intestine, in about three hours after the taking of 
food (Roberts). 

In cases of very weak digestion, Roberts suggests the employment 
of " peptonized " foods — i. e., foods that have been acted on by pan- 
creatine and the proteids converted into peptones. The following 
formulae proposed by Roberts will be found useful in some conditions 
of disease : 

" Peptonized Milk. — A pint of milk is diluted with one-fourth 
water, and heated to 140° Pahr. Two or three teaspoonfuls of liquor 
pancreaticus, and ten to twenty grains of bicarbonate of soda, are 
then mixed therewith. The mixture is then poured into a covered 
jug, and the jug is placed in a warm situation under a ' cosey ' in order 
to keep up the heat. At the end of an hour or hour and a half, the 
product is boiled for two or three minutes. It can then be used like 
ordinary milk." 

" Peptonized Gruel. — Gruel may be prepared from any of the nu- 
merous farinaceous articles which are in common use — wheaten flour, 
corn-meal, oatmeal, arrow-root, sago, pearl-barley, pea-flour. The 
gruel should be very well boiled, and made thick and strong. It is 
then poured into a covered jug and allowed to cool to a temperature 
of about 140° Pahr. Liquor pancreaticus is then added in the propor- 
tion of a tablespoonful to the pint of gruel, and the jug be kept warm 
under a 'cosey ' as before. At the end of a couple of hours the prod- 
uct is boiled and finally strained." In this process the starch is con- 



PEPSIX. 83 

verted into sugar, and the albuminoid matters are peptonized, whence 
the gruel assumes a thin, watery consistence. Peptonized gruel is 
administered with peptonized milk. 

Peptonized milk-gruel is prepared as follows : Gruel is prepared 
in the usual way, thick and strong ; to this while boiling is added an 
equal measure of milk. To each pint of the mixture add two or three 
tcaspoonfuls of liquor pancreaticus and twenty grains of bicarbonate 
of sodium. It is kept warm for a couple of hours, then boiled for a 
few minutes and strained. 

Antagonists and Incomtatibles. — Alkalies and the mineral salts 
which precipitate pepsin from its solutions (mercury, lead, zinc, and 
copper salts), tannic and gallic acids, creosote, etc., are incompatible. 
Alcohol and the various alcoholic liquors, in sufficient strength, destroy 
the activity of pepsin ; hence the wine of pepsin must be an uncertain 
preparation. 

Synergists. — Lactic and chlorhydric (muriatic), acetic, citric, and 
malic acids, promote the digestive activity of pepsin. Certain fer- 
ments, as ptyaline, pancreatine, extract of malt, etc., also increase its 
activity. 

Physiological Effects. — Ten grains of the saccharated pepsin, 
prepared by the process of Scheffer, will dissolve 120 grains of 
coagulated albumen in four to six hours, at a temperature of 100° Fahr. 
Pepsin is an essential constituent of the gastric juice, and possesses the 
property, especially in the presence of lactic and chlorhydric acids, of 
digesting the nitrogenous constituents of the food (caseine, albumen, 
fibrine, etc.), and converting them into peptones. 

Therapy. — Pepsin is, of course, indicated in stomach-disorders, 
characterized by a deficiency of this essential principle. As Fen wick 
has shown, the amount of pepsin secreted by the gastric glands under- 
goes great diminution in various morbid states, as in cancer, diabetes, 
typhoid fever, and heart-disease. In convalescence from fever, there- 
fore, pepsin is indicated, and in the incurable morbid states, mentioned 
above, it serves a useful purpose in maintaining the function of diges- 
tion. Fox " bears strong testimony in favor of pepsin " (p. 74), in cases 
of atonic dyspepsia, and " irritative states of the mucous membrane." 
He prefers to administer it with chlorhydric acid. In the atonic dyspep- 
sia of phthisis pepsin is highly beneficial, especially when given in 
connection with pancreatic emulsion. In other forms of dyspepsia, ac- 
companied by imperfect solution of the fats and the formation of fat- 
acids, the addition of pancreatic solution greatly increases the activity 
of pepsin (Long). 

In the apepsia of infants (Barthez), especially occurring in those 
artificially fed, great benefit is derived from the use of pepsin. Dr. 
Cummins has seen many apparently hopeless cases recover under its use, 



84 RESTORATIVE AGENTS. 

and he regards it as so valuable that he never recommends a wet-nurse, 
but relies on artificial food, the digestion of which is aided by the ad- 
ministration of pepsin. Corvisart used his nutritive powder (the so- 
called Boudault's pepsin) with happy effects in the same cases ; and 
Barthez, who applied the term apepsia to this inability of infants to di- 
gest their proper aliment, has been equally successful in the same mode 
of treatment. The saccharated pepsin should be administered in these 
cases in doses of five to ten grains immediately after the child has taken 
its milk or other food, or ten or fifteen drops of the glycerole of pepsin 
at the same time. It is better, according to M. Barthez, to give pepsin 
without acid to infants (Trousseau et Pidoux). 

Pepsin is one of the remedies which have been used with success in 
the vomiting of pregnancy. 

By facilitating digestion, pepsin relieves the pain and distress caused 
by deficient elaboration of the foods; hence its utility in relieving tlie 
heaviness and torpor which are felt during the progress of digestion in 
some subjects, and also the gastralgia which is produced in this way. 

According to Hollman, the use of pepsin is attended with beneficial 
results in anosmia, chlorosis, atrophy, and allied states, due, no doubt, 
to the better preparation of the peptones for absorption into the blood. 

In chronic ulcer of the stomach and in cancer of this organ, pepsin, 
by facilitating digestion, will diminish the distress of the patient and 
will contribute to the cure of ulcer and prolong life in cases of cancer. 

Very great success has been attained in the treatment of diarrhoea 
in infants by pepsin. The form of diarrhoea amenable to this remedy 
is due really to an atonic state of the intestinal mucous membrane. 
Every motion contains half-digested food. Soon after taking milk or 
other food, the child becomes uneasy and a discharge takes place. Fre- 
quently undigested food is vomited as well. If this condition of things 
continues for any considerable time, the child emaciates, and the skin 
wrinkles and becomes dry and harsh. The motions will be quickly 
changed'in character, and the nutrition of the child improved, by giving 
pepsin immediately after each supply of food. Facts in illustration of 
this statement have been published by Corvisart, Barthez, Rilliet, Trous- 
seau et Pidoux. Ellis, of Dublin, Davidson, of Liverpool, Hawley, of 
Brooklyn, and others. 

In cases of entire inability of the stomach to digest food, or when 
surgical operations or accidental injuries prevent the introduction of ali- 
ment into this viscus, pepsin is added to the nutritive enemeta in order 
to insure the preparation of peptones for absorption. 

Pepsin is also applied to certain local uses. After the publication 
of Broadbent's results from the injection of acetic acid into cancerous 
tumors, Thiersch and Nussbaum introduced the method of gastric-juice 
injections into the substance of morbid growths. The gastric juice of 
the pig carefully filtered, or a slightly acidulated solution of pepsin, may 



LACTIC ACID. 85 

be employed for this purpose. The injection should be made with an 
hypodermic syringe, and the solution should be deposited well into the 
interior of the tumor. This practice may be useful in cases of fatty 
tumor or other benign growths, when from any cause extirpation may 
not be practicable. That malignant tumors may be retarded in growth 
by this practice is also quite probable, unless the neighboring lymphat- 
ics are involved. 

Authorities referred to : 

Cummins, Dr. W. Jackson. Dublin. Journal of the Medical Sciences, February, 1872. 

Davidson, Dr. A. The Practitioner, voL viii., p. 131. 

Ellis, Dr. G. A. TJie Medical Times and Gazette, July 19, 1862. 

Fenwick, Dr. Samuel. The Morbid Stales of the Stomach and Duodenum, London, 
1868, pp. 394. 

Fox, Dr. Wilson. On the Diseases of the Stomach, London, 1872, pp. 236. 

Gubler, Prof. A. Commentaires Therapeuliques du Codex Medicamentarius, Paris, 
1868, pp. 714. 

Hollman, Dr. J. P. Schmidt's Jahrbucher der gesammtcn Medicin, vol. exxxi., p. 165. 

Long. Pharmaceutical Journal, London, 1870, quoted in Wood's New Remedies. 

Meisner, Prof. Ueber Krebs, Schmidt's Jahrbucher, etc., vol. cxlvi., p. 346. 

Nussbaum, Prof. Schmidt's Jahrbucher, etc., vol. exxxv., p. 38. 

Roberts, Dr. William. Lumlcian Lectures, On the Digestive Ferments, April 3, 
1880, April 10, 17, 24, and May 1, 8, 15, 22, and 29, 1880. 

Stephenson, Dr. W. Edinburgh Medical Journal, November, 1865. 

Trousseau et Pidoux. Traite de Therapeutique et de Matiere Medicate, huitieme 
edition, vol. i., p. 64. 

Acidnm Lacticum. — Lactic acid ; acide lactique, Fr. ; Milchsaurc, 
Ger. 

Properties. — Sour, sirupy liquid, having a pale wine-color. Specific 
gravity 1.212. Mixes in all proportions with water, alcohol, and ether. 

Incompatibles and Antagonists. — Alkalies and the mineral salts. 

Synergists. — Pepsin, sodium-chloride, vegetable acids, chlorhydric 
acid. 

Dose. — Fifteen minims to 3 ss in sweetened water. 

Physiological Action. — As lactic acid is a frequent constituent of 
the gastric juice, it has undoubtedly an important function in connection 
with digestion. Used medicinally it promotes the appetite and facilitates 
digestion. In large doses ( 3 j) it gives rise to epigastric pain, flatu- 
lence, and loss of appetite. As lactic acid is one of a series of homolo- 
gous acids, containing butylactic, valerolactic, and leucic acids, it is not 
improbable that some of these may result from its oxidation when ad- 
ministered in excess. It probably combines with bases and forms lac- 
tates, for it displaces not only the volatile but some of the mineral acids 
from their combinations. Chemical investigations have indeed con- 
firmed this, for, besides free lactic acid, lactates have been found in the 
gastric juice. It is not known definitely whether free lactic acid occurs in 
the blood in the healthy state, but it certainly does in some morbid con- 



g6 RESTORATIVE AGENTS. 

ditions. According to Lehmann, lactates are rapidly converted into car- 
bonates in the blood. Free lactic acid, as was long ago shown by Ber- 
zelius, is found in muscular fluid, and has also been detected in the 
spleen by Scherer. Although it is not always a constituent of normal 
urine, yet, when the supply of lactates to the blood is considerably be- 
yond the oxidizing power of the blood, it has been found (Lehmann). 
Scherer has shown also that lactic acid is present in the exudates of 
puerperal fever. 

Lactic acid has the power to dissolve a considerable quantity of 
freshly-precipitated phosphate of lime. 

The suggestion made by Prout, of a relation between an excess of 
lactic acid in the blood and rheumatic inflammation, received a remark- 
able confirmation in the experiments of Richardson, who produced 
endocardial inflammation by injecting lactic acid into the peritoneal 
cavity of dogs. Further confirmation of this connection has been af- 
forded in the attacks of acute rheumatism which have occurred in sub- 
jects of diabetes treated by lactic acid. 

Therapy. — Solutions of lactic acid are of great utility as solvents of 
false membrane. Since the comparative demonstration of solvents 
made by Bricheteau and Adrian, it has been employed successfully by 
Dr. Weber, of Darmstadt, and Dr. Dureau, in croup, applied by means 
of a pulverisateur in the strength of thirty to forty drops to the ounce 
(Waldenburg). The following is the formula of Morell Mackenzie of 
the London Throat Hospital : R. Acidi lactici, 3 iijss. ; aquae destil., 3 s. 
M. This may be used in a spray-producer, or be applied on a mop to 
the affected part. It is unquestionably an excellent solvent of the exu- 
dation of diphtheria, as the author has frequently observed. It may be 
used also as a gargle when the exudation does not extend beyond the 
tonsils and the pillars of the fauces. For this purpose sufficient acid may 
be added to water to give a distinctly sour taste. As the application 
is free from danger, it may be used as often as every half-hour. "When 
used in the form of spray, care must be had to prevent the acid hurting 
the eyes. 

It is chiefly in atonic dyspepsia that lactic acid is employed. In this 
condition lactic acid is, so to speak, a physiological remedy, for we sup- 
ply it artificially because the stomach is unequal to the task of produ- 
cing it. Generally, it is advisable to combine pepsin with it thus : R. 
Gl}'c. pepsinas, 3 xij. ; acidi lactici, 3 iv. M. A teaspoonful three times 
a day after meals is a proper dose for an adult. In the apepsia of in- 
fants, characterized by the presence of undigested aliment in the dis- 
charges, this combination is an excellent remedy. If a marked degiee 
of acidity exist, the acid should be omitted, or given before the milk, 
when it may prevent the excessive production of acid. In irritative 
dyspepsia, when the pain and suffering are due to slow and imperfect 
digestion, lactic acid will often give great relief either alone or combined 



MINERAL ACIDS. 87 

«vith pepsin. Cases of acidity and heartburn are often quickly re- 
lieved by lactic acid given before meals. When the presence of an ex- 
cess of the phosphates, uric acid, and the urates, and of oxalate of lime, 
in the urine, is due to imperfect digestion and faulty assimilation, as is 
frequently the case, lactic acid is serviceable, and its utility is solely due 
to the good effect ifc has in promoting digestion. Over the other forms 
of these so-called diatheses it has no influence. 

Lactic acid has been used with varying success in the treatment of 
diabetes. The object to be gained is the prevention of sugar formation 
from the starchy and other elements of the food. Dr. Foster reports 
some cases apparently decidedly benefited and Dr. Ogle gives an ac- 
count of two cases in which no good results were attained. Cases have 
been lately reported in which the patients were improved by the use of 
lactic acid, but on the whole the utility of this agent in diabetes must 
be held to be as yet subjudice. 

Disappointment in the use of lactic acid is frequently experienced 
from the poor quality of the drug. 

Authorities referred to above : 

Bricheteau, Dr. Felix: Bulletin General de Tlierapeutique, vol. lxxiv., p. 72. 

Butler, Dr. N. L. Treatment of Croup by Lactic-Acid Spray. The Practitioner, vol. 
vii., p. 189. 

Dureau, Dr. Bulletin General de TJierapentique, vol. lxxxiii., p. 45. 

Jaffe, Dr. Die DipMherie, Schmidt's Jahrbucher der gesammien Medicin, vol. cxlix., 
p. 321. 

Ogle, Dr. John W., and Dr. Balthazer Foster. British Medical Journal. 

Lehmakn, Prof. Dr. C. G. Physiological Chemistry, American edition, vol. i., p. 
85, et se'q. 

Mackenzie, Dr. Morell. The Pharmacopoeia of the Hospital for Diseases of the 
Tliroat, London, 1872. 

Nothnagel, H. Handbvch der Arzneimittellehre, Berlin, 1870, p. 376. 

Ranke, Prof. Dr. J. Grundz'uge der Physiologie des Menschen, zweite Auflage, Leipzig, 
1872, p. 248. 

Waldenburg, Dr. L. Die locale Behandlung der Krankheiten der Athmungsorgame, 
Berlin, 1872, p. 403. 

Wood and Bache. U. S. Dispensatory, thirteenth edition, p. 48, et seq, 

ACIDS. 

Mineral. — Acidum Sulplwricum. — Sulphuric acid ; specific gravity, 
1.843. 

Acidum Sulphuricum Dilutum. — Dilute sulphuric acid. (Sulphuric 
acid two troy ounces, water to a pint.) Dose, five to twenty drops 
well diluted. 

Acidum Sulphuricum Aromaticum. — Aromatic sulphuric acid, elixir 
of vitriol. (Sulphuric acid six troy ounces, ginger a troy ounce, cinna- 
mon a troy ounce and a half, alcohol two pints.) Dose, five to thirty 
drops well diluted. 



88 RESTORATIVE AGENTS. 

Acidum Sulphurosum. — Sulphurous acid ; specific gravity, 1.035. 

Acklum Muriaticum. — Muriatic or chlorhydric acid ; specific gravity, 
1.160. 

Acidum, Muriaticum Dilutum. (Muriatic acid four troy ounces, 
water to a pint.) Dose, five to twenty drops well diluted. 

Acidum Nitricum. — Nitric acid ; specific gravity, 1.420. 

Acidum Nitricum Dilutum. (Nitric acid three troy ounces, water 
to a pint.) Dose two to fifteen drops well diluted. 

Acidum Nitro-Muriaticum. — Nitro - muriatic acid. (Nitric three 
troy ounces, muriatic five troy ounces.) 

Acidum Nitro-Muriaticum Dilutum. (Nitric acid one and one-half 
troy ounce, muriatic two and one-half troy ounces, water to a pint.) 
Dose, two to fifteen drops well diluted. 

Acidum JPhosphoricum Dilutum. — Specific gravity, 1.056. Dose, 
two to fifteen drops in water well diluted. 

Antagonists and Incohpatibles. — Alkalies and their carbonates, 
salts of lime and lead. 

Synergists. — Bitters. 

By assisting digestion and by correcting an abnormal condition of 
the alimentary mucous membrane, acids directly contribute to the blood- 
forming process, and indirectly, through the blood, to the construction of 
tissue, and the bettering, in general, of the bodily condition. 

Physiological Actions. — The mineral acids grouped above agree 
in the general qualities of their actions, but differ in some particulars. 
They attack the living tissues with great energy, abstract the water and 
combine with the potash, soda, and lime bases. In virtue of this affinity 
for water and this power of combination with bases, they cause destruc- 
tion of tissue and are called escharotics. Some of them are more power 
ful than others: thus, sulphuric and phosphoric acids penetrate more 
deeply than the others. Nitric acid stains the skin yellow ; sulphuric 
.acid carbonizes or blackens. Hence in cases of accident, or when these 
acids are used with criminal intent, it is verv obvious at a glance which 
has been taken or given : nitric acid making a yellow stain of the face, 
lips, and mouth, and sulphuric carbonizing or blackening those parts. In 
the stomach they produce the same effects. When concentrated they 
destroy the mucous membrane of the mouth, epiglottis, oesophagus, and 
stomach. The systemic effects are those of the irritant and corrosive 
poisons. The appropriate remedies are chemical and mechanical : alka- 
lies, magnesia, soda, lime, soap, to neutralize the acid ; and eggs, milk, 
oil, etc., to protect mechanically the tissues. The depression of the pow- 
ers of life which immediately follows the ingestion of a mineral acid 
should be treated by opium, nutrient and stimulating enemata, and the 
intra-venous injection of ammonia. 

The mineral acids, when administered in medicinal doses, must on 
reaching the stomach act in accordance with their chemical position. 



MINERAL ACIDS. 89 

They will combine with the bases and form salts. Hydrochloric, and to 
a less degree phosphoric, aid digestion, acting as synergists to pepsin, 
and contribute to the formation of peptones. Sulphuric unites with 
bases to form insoluble sulphates, and precipitates the albuminous sub- 
stances from their solution in the gastric juices ; hence this acid, although 
for a brief period it improves digestion, soon disorders it. It is true of 
all the mineral acids that their long-continued use diminishes the pro- 
duction of acid gastric juice, and in this way after a time they cause the 
very troubles for the relief of which they were originally administered. 
An acid solution on one side of an animal membrane, and an alkaline 
solution on the other, is the condition most favorable to osmosis. Hence 
the introduction of an acid into the stomach with sufficient frequency 
and in sufficient quantity must impair the production of acid gastric 
juice. In practice this is found to be the case. The mineral acids are 
among the most diffusible substances known, and of these hydrochloric 
stands at the head. So much of these acids as do not enter into com- 
binations in the stomach diffuses quickly into the blood, and the salts 
which they form by combination with bases follow the laws of diffusion 
according to their class. The acids, especially the hydrochloric, and 
next nitric, diminish the alkalinity of the blood, and in this way accom- 
plish all that they are capable of doing as systemic remedies. 

Therapy. — Not much need be said of the use of the mineral acids 
in affections of the mouth and throat. Formerly they were much em- 
ployed in the treatment of mercurial and other forms of stomatitis, 
diphtheria, aphthae, gangrene, etc. 

In using mineral acids in affections of the mouth, it should not be 
forgotten that they attack the enamel of the teeth. First, the animal 
matter adherent to the teeth is dissolved off, when the teeth are said to 
be " set on edge." The acid should be applied to the affected surface 
only, and the mouth should afterward be washed out with an alkaline 
lotion. Pure hydrochloric acid may be applied with a camel's-hair brush 
or on a bit of soft pine-wood to the gums in cases of sloughing from 
mercurial stomatitis, and to the ulcers of stomatitis materna, to syphi- 
litic mucous patches, and to those painful ulcers of the mouth which 
occur periodically in some subjects affected with a peculiar form of in 
digestion. In the case of ulcers having their origin in stomach-dis- 
order, the internal use of hydrochloric, nitric, or nitro-muriatic acid, is 
often extremely beneficial. 

The local use of hydrochloric acid in diphtheria, so strongly urged 
by Bretonneau, is now rarely employed, for it is well known that the 
diphtheritic exudation will rapidly extend over an inflamed surface pro- 
duced by the application of the acid, and the destruction of the exuda- 
tion at one part does not prevent its extension and renewed formation. 

Any of the mineral acids administered by the stomach should be 
well diluted, and to prevent injury to the teeth should be taken through 



90 RESTORATIVE AGENTS. 

a glass tube or a straw. The mouth should also be rinsed out after 
swallowing the acid. 

The mineral acids are highly useful in certain stomach-diseases. In 
atonic dyspepsia hydrochloric acid should be given after meals, or better, 
lactic acid. It is highly probable that hydrochloric acid is produced 
during digestion by the reaction between chloride of sodium and lactic 
acid. A combination of the acid with pepsin, as already suggested, is 
preferable in these cases of atonic dyspepsia. When, in consequence 
of faulty digestion, acetic, lactic, and butyric acids are produced in the 
stomach from the starchy, saccharine, and fatty constituents of the food, 
the acids given after meals add to the distress of the patient. 

To prevent the excessive formation of acid, whether due to the ac- 
tion of the gastric glands, or to abnormal fermentation of the starchy, 
saccharine, and fatty elements of the food, mineral acids are used with 
decided advantage, but they must be administered before meals. For 
this purpose, hydrochloric or phosphoric acid is to be preferred. The 
excessive production of acid is manifested by acid eructations, pjyrosis, 
heartburn, and ulcerative stomatitis. 

There is a form of indigestion characterized by eructations of offen- 
sive gas, painful digestion, a sallow complexion, and by the appearance 
of oxalate-of-lime crystals in the urine, and is accompanied by mental 
despondency. This state of things is relieved by the nitro-muriatic 
acid. 

The experience of English physicians practising in India has been 
favorable to the use of nitro-muriatic acid in chronic hepatic affections, 
and in dysentery and dropsy of hepatic origin. Acute diseases of the 
liver, and such chronic affections as cirrhosis and waxy degeneration, 
are not as a rule benefited by the mineral acids. JSIucous duodenitis 
and catarrh of the gall-ducts accompanied by jaundice, and jaundice 
of malarial origin, are forms of hepatic disease in which nitro-muri- 
atic acid is serviceable. With the internal use of the acid should be 
conjoined the local use to the right hypochondrium of the acid-bath. 
Three ounces of nitro-muriatic acid to a gallon of water is a suitable 
strength for the topical use in this way. The feet may be placed' in the 
bath, and the legs, arms, and abdomen, may be alternately sponged, when 
the skin is torpid and its secretion defective. The temperature of the 
bath should be about 96° Fahr. (Martin). Another mode of making 
topical application of the acid-bath is as follows : " Let a flannel roller 
of ten or twelve inches wide, and sufficient to encircle the body twice, 
be soaked in the fluid and then wrung so as to remain only damp. Ap- 
ply this instantly to the body, covering it with a piece of oiled-silk to 
avoid damping the dress. It should be worn constantly, but should be 
changed, soaked, and wrung, morning and evening" (Squire). This is 
a very effective local application in the hepatic disorders mentioned 
above as amenable to the treatment bv the mineral acids, and is service- 



MINERAL ACIDS. 91 

able in the first stage of cirrhosis. Dr. Scott, of Bombay, ascribes to the 
acid-bath the power to relieve the pain of hepatic colic, by causing the 
expulsion of the impacted calculus. 

The mineral acids are very effective remedies in the treatment of 
summer and colliquative diarrhoea. Crapulous diarrhoea and dysen- 
tery are not benefited by them. The indications for their use are these: 
painless, watery evacuations, of a light color, alkaline in reaction. 
Hope's mixture, which contains nitrous acid, has long been used with 
success, in such cases. The formula is as follows : I£. Acidi nitrosi, 3 j ; 
tincturas opii, gtt. xl; aquas camphorse, |viij. S. One-fourth to be 
taken every three or four hours. A mixture of this kind ma)' readily be 
extemporized, in which the relative proportion of the acid and opium 
may be arranged according to the indications of the case. Sulphuric 
acid is more decidedly astringent than nitric and muriatic, and is, 
therefore, as a rule, to be preferred in diarrhoea. Bence Jones places 
them as regards their actions thus : Hydrochloric more promotes diges- 
tion ; nitric acid, secretion; and sulphuric, astringency. Nitric and nitro- 
hydrochloric are, according to this view, better suited to stomach and 
hepatic disorders characterized by deficient secretion, and sulphuric is 
more appropriate for the relief of a relaxed state of the mucous mem- 
brane. A combination of aromatic sulphuric acid with opium is one of 
the most effective remedies we possess in the treatment of summer diar- 
rheea and cholera. Sulphuric acid may also be used with advantage in 
the treatment of dysentery, in combination with sulphate of magnesia. 
I£. Magnesias sulphat., § j ; acidi sulphur, dil., 3 ij ; morphise sulph., gr. j ; 
aquas, |iv. M. S, A tablespoonful every three or four hours. After the 
action of a saline laxative, Hope's mixture, or an extemporized prescrip- 
tion of a similar kind, may be used. When the mineral acids do not 
quickly improve the discharges, and lessen their frequency, and when 
they increase the tormina and tenesmus, they should be suspended. In 
the treatment of cholera, dilute or aromatic sulphuric acid may be given 
frequently, well diluted in full doses. Opium can be added at such 
intervals as may be indicated. 

Mineral acids, especially the muriatic, are very serviceable in fevers. 
They were formerly classed as refrigerants, or cooling medicines, and 
were supposed to allay thirst and to diminish fever. Although these 
notions are no longer entertained, the acids are known to render an im- 
portant service in fevers. They increase secretion of the mucous mem- 
brane, and thus relieve the dryness of the tongue and fauces. As in 
fevers the gastric juice is deficient in acids, digestion is materially aided 
by their administration. In typhoid fever, the acids restrain somewhat 
the exhausting diarrhoea, increase the digestive power, and remove or 
diminish the dryness of the tongue. It is probable that they exert an 
influence on the composition of the blood, beyond the increased activity 
which they impart to the primary assimilation. Hydrochloric acid is 



92 RESTORATIVE AGENTS. 

preferable in the treatment of fevers. It may often be advantageously 
administered in beef-juice. 

In scarlet fever, hydrochloric acid is frequently combined with 
chlorate of potassa (producing euchlorine), but it is better administered 
alone in this disease. Besides the internal administration of the acid, 
it is often mixed with Water and used as a gargle, or mixed with honey 
and applied with a brush to the throat. One part of acid to five parts 
of honey or ten of water is a strong enough solution for this purpose, 
In the other eruptive fevers, hydrochloric acid is serviceable to allay 
thirst, to increase digestion and to obviate the tendency to ad} T namia in 
these diseases. To children, the dilute hydrochloric acid maybe readily 
administered in lemonade or in sirup of lemons. 

There is no doubt of the value of the acids, especially the nitre- 
muriatic, in the treatment of constitutional syphilis. This remedy is 
not to be compared in efficiency with mercury and iodide of potassium, 
but in chronic cases saturated, so to speak, with these approved reme- 
dies, in which syphilitic patches persistently reappear in the mouth, 
nitro-muriatic acid often renders important service. It is undoubtedly 
true that constitutional syphilis has been treated successfully by the 
acids alone, but a very rigidly abstemious dietary has been enforced in 
these cases. It has already been shown that the denutrition method is 
of itself sufficient in some cases to relieve the organism of constitutional 
infection. How much of the result is to be ascribed to the remedy, and 
how much to denutrition, is not clear. 

Nitric acid has been used with success in the treatment of intermit' 
tent fever by Hammond, Bailey, and others. In order to obtain a cura- 
tive effect, it is necessary to give the acid in full doses every four or six 
hours. This acid is of great service, also, after an arrest of the parox- 
ysms of intermittent by quinia to remove the hepatic congestion, and ■ 
the changes in the glandular apparatus of the intestines, induced by the 
fever-movement. It may be advantageously combined with the bitters, 
or used instead of the aromatic sulphuric acid in the preparation of the 
officinal infusum cinchona} flavai. 

The mineral acids have long been used with more or less advantage 
in the treatment of phthisis. Their utility obviously depends on the 
fact that they supply to the digestive fluids a material in which they are 
deficient in this disease. As F«nwick has shown, both pepsin and acid 
occur in quantity much less than normal in the gastric juice of phthisi- 
cal subjects. The acid best suited for the treatment of the indigestion 
of phthisis is the officinal acidum muriaticum dilutum. 

Nitric acid is one of the numerous remedies used in whooping-cough. 
It is frequently successful in shortening the duration of the disease, and 
moderating its violence ; but it acts much more beneficially after the 
subsidence of the catarrhal stage. It should be given well diluted in 
sweetened water. Chronic bronchitis and hoarseness produced by 



MINERAL ACIDS. 93 

singing are said to be relieved by ten-minim doses of dilute nitric 
acid. 

The mineral acids, especially the hydrochloric, have lately been pro- 
posed as remedies for acute rheumatism. The unquestionable utility 
of the tincture of the chloride of iron in rheumatism lends support to 
this practice. It is highly probable that the mineral acids check the 
formation of lactic acid in the blood. Whatever may be the nature of 
the action, good results from the treatment have been reported (Dr. 
J. James Ridge). 

Some of the accidents due to lead are prevented, and relieved when 
they occur, by sulphuric acid. Sulphuric-acid lemonade is used by 
workmen in lead-factories to prevent lead-poisoning. This is supposed 
to act by forming the insoluble sulphate of lead. Dilute sulphuric acid 
is also effective in the treatment of lead-colic. The constipation due to 
lead is relieved by a combination of sulphuric acid and sulphate of 
magnesia, and the lead-cachexia is much benefited by a prescription of 
Bulphate of quinia, sulphate of iron, and dilute sulphuric acid. The ef- 
fects of lead on the nervous system are not removed by sulphuric acid. 

Sulphuric acid is sometimes very effective in uterine haemorrhage. 
It has seemed to the author to be more useful in the case of haemor- 
rhage due to fibroid or polypus than the flow arising from other causes. 
Although sometimes prescribed for pulmonary haemorrhage, it is not 
equal to other remedies. In intestinal haemorrhage sulphuric acid acts 
directly in part, and is therefore serviceable. In purpura it sometimes 
acts happily. 

The aromatic sulphuric acid has long been used to check profuse 
sweating, especially the sweating of phthisis. It is certainly service- 
able in this condition, but objectionable because of the ill effects of the 
acid on the function of digestion. If used at all, it should not in any 
case be long continued. 

Nitric and nitro-hydrochloric acids have also been used with advan- 
tage in such diseases of the skin as lepra, impetigo, acne, erythema 
nodosum, and others, in which the skin-affection is symptomatic of 
imperfect digestion and assimilation. 

In certain morbid states of the urine, as the phosphatic diathesis, 
oxaluria, alkalinity of the urine from disease of the urinary mucous 
membrane, and phosphatic calculus, the mineral acids render important 
service. In chronic cystitis and phosphatic deposits, a very weak solu- 
tion of nitric acid (gtt. j — § j) may be injected with advantage. In 
using such injections it is to be remembered that the bladder is ex- 
tremely intolerant, and hence they should be permitted to escape im- 
mediately. When uric acid is in excess in the urine from faulty diges- 
tion and assimilation, hydrochloric acid is often of great service : the 
excess of uric acid disappears because the foods are more perfectly pre- 
pared for admission into the blood. 



94 RESTORATIVE AGENTS. 

Local ob ToricAL Uses of the Mineral Acids. — Some allusions 
have been made to the local application of muriatic acid in diseases of 
the throat and of the acid-bath in hepatic affections. It will not be 
necessary to recapitulate on these points. 

Nitric acid is one of the most efficient escharotics for the destruction 
of specific or unhealthy ulcers. It is the most frequently -used caustic 
for the destruction of chancroid, sloughing, or phagedenic chancre. A 
glass rod or bit of pine is dipped into the acid and applied, care being 
taken to penetrate to all the sinuosities of the sore. The surrounding 
healthy tissue may be protected from injury by the previous application 
of oil, and, when the acid has sufficiently penetrated, its further action 
may be arrested by some alkaline wash'. A water-dressing, or spirit 
and water, or dilute tincture of benzoin, or some similar application, 
may be afterward applied to the sore. Ordinary indurated chancre does 
not require escharotic applications. JTospital gangrene, or a gan- 
grenous condition of wounds, injuries, or ulcers, is similarly treated 
with advantage, and probably no form of caustic is more desirable than 
nitric acid for these purposes. Ordinary torpid and ill-conditioned 
ulcers are improved and put in the way of healing by frequent washing 
with a weak lotion of nitric acid ( § j — Oj). The same solution will 
remove mucous patches and condylomata, and will often check the 
bleeding from haemorrhoids. 

Nitric acid is one of the means employed for the removal of haemor- 
rhoids. It is not effective, however, against all forms. Large haemor- 
rhoids are much better treated by the ligature, galvano-caustic loop, or 
other radical measures. The so-called " strawberry-pile," a small 
hasmorrhoid of red color, which consists of a congeries of arterial twigs, 
and which bleeds freely, can be effectually destroyed by nitric acid. 
The pile should be exposed, usually through a speculum, and the strong 
nitric acid be applied on a pine-stick freely, followed by an abundant 
application of olive-oil to prevent the extension of the escharotic action 
to the surrounding parts. Small, superficial neevi are treated success- 
fully in the same way. 

Sulphuric acid penetrates more deeply than nitric, and its escharotic 
action is not so easily limited ; hence, it is not so frequently employed 
for the destruction of sloughing and ill-conditioned ulcers. It is some 
times used in the form of Ricord's paste to chancres, sloughing, or 
phagedenic. The paste is made by the addition of sufficient charcoal 
to strong sulphuric acid to give it the proper consistence. This is 
spread on a piece of muslin of a size equal to the sore, and is allowed to 
remain on until an eschar is produced, when an ordinary poultice may 
be applied. 

A favorite liniment of Sir Benjamin Brodie for counter-irritation 
of diseased joints is made by the addition of sulphuric acid to olive-oil 
( 3 j of the acid, $ iv of olive-oil). 



OILS AND FATS. 95 

A general bath in, or sponging the body with, a solution of nitro- 
muriatic acid — one ounce to a gallon — is very serviceable in the case of 
cachectic children who present these symptoms : a dry and wrinkled 
skin, sallow complexion, capricious appetite with a taste for dirt-eating, 
and whitish, pasty motions. Applying to the surface of the body an 
acid solution must affect the constitution of the blood, for an acid solu- 
tion on one side of an animal membrane and an alkaline fluid on the 
other are the conditions most favorable to osmosis. 

Lately, Dr. Lombe Atthill, of Dublin, has called attention to the 
" use of nitric acid in the treatment of uterine disease." He applies the 
fuming nitric acid to the interior of the uterine cavity after previous 
dilatation with sponge or laminaria tents. In order to protect the cer- 
vix and cervical canal he introduces an intra-uterine speculum with 
expansible blades. The cavity is first mopped out and dried with cot- 
ton ; then a probe, wrapped with cotton, is dipped in fuming nitric acid 
and applied thoroughly to the mucous membrane. This practice is very 
effective in the treatment of intra-mural fibroids and fungous granula- 
tions, to restrain haemorrhage, and after the removal of polypi. He 
almost invariably employs nitric acid in the treatment of granular cervi- 
citis and endo-cervicitis, " with the best results." When decided ten- 
derness of the uterus' exists, he advises that this be first removed by 
suitable measures. 

Authorities referred to above : 

Atthill, Dr. Lombe. Obstetrical Journal of Great Britain and Ireland, June, 1873. 

Bretonneait. Des Inflammations Speciales du Tissu Muqueux, et en particulier de la 
Diphtherite, Paris, 1826, p. 242, et seq. 

Fox, Dr. Wilson. The Diseases of the Stomach, Macmillan & Co., 1 872, p. ] 40. 

Gubler, Dr. Adolph. Commentaires Therapeutiques du Codex Medicamentarius, Paris, 
1868, p. 464. 

Mackenzie, Dr. Morell. Pharmacopoeia of the Throat Hospital, p. 35- 

Martin, Sir Ranald. London Lancet, December 9, 1865. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, Berlin, 1870, p. 878, 
et seq. 

Ridge, Dr. J. James. The Medical Times and Gazette, vol. ii., 1871. 

Ringer, Dr. Sidney. A Handbook of Therapeutics, third edition, p. 97, et seq. 

Squire. Companion to the British Pharmacopoeia, 1871, p. 12. 

OILS AND FATS. 

Adeps. — Lard. Saindoux, Fr. ; ScJiweineschmalz, Ger. — Below the 
temperature of 90° Fahr. a soft solid. 

Sevum. — Suet. Suif de mouton, Fr. ; Schopsentalg, Ger. The pre- 
pared suet of ovis aries. 

Oleum Amygdalae expressum. — Almond-oil. Huile d'amandes, Fr. ; 
Silsse 3fandeln, Ger. The fixed oil obtained from the kernel of the 
fruit of the Amygdalus communis. 



96 RESTORATIVE AGENTS. 

Oleum Theobromce. — Cacao-butter. Beurre de cacao, Fr. ; cacao- 
butter, Ger. The concrete oil of the kernels of the fruit of Theobroma 
cacao. 

Oleum Lini. — Flaxseed-oil. Huile de lin, Fr. ; Leinbl, Ger. The 
fixed oil obtained from Linum usitatissimum. 

Oleum Olivce. — Olive or sweet oil. Huile d'olive, Fr. ; Olivenbl, 
Ger. The fixed oil obtained from the fruit of Olea Europa. 

Composition. — The above-mentioned oils and fats differ in the quan- 
tity of oleine, stearine, and margarine, which they respectively contain, 
and hence differ in physical qualities. Lard is composed of 38 per cent, 
of stearine and margarine and 62 per cent, of oleine, and olive-oil of 72 
per cent, of oleine and 28 per cent, of margarine. The more solid fats, 
as suet, contain much stearine. These neutral fats are, chemically, 
combinations of an acid (stearic, palmitic, margaric, oleic) with a base, 
glycerine. The oleine of linseed-oil appears to differ from ordinary 
oleine by furnishing a different acid — linoleic — when saponified. 

Oleum morrhuoB. — Cod-liver oil. Huile de morue, Fr. ; Leberthran, 
Ger. The fixed oil obtained from the liver of Gadus morrhuoz and 
other species of Gadus. 

Composition. — Cod-liver oil contains a peculiar principle, gaduin, 
and vields, by distillation with ammonia, propylamin. It also differs 
from the fats and oils above described in containing various biliary 
principles and traces of iodine, bromine, phosphorus, sulphuric and phos- 
phoric acids, lime, magnesia, soda, and iron. It agrees with the other 
oils in being composed for the most part of oleine and margarine. It is 
the latter constituent which gives the white cloudiness of cod-liver oil 
in cold weather, and which is, by the " British Pharmacopoeia," directed 
to be separated by artificial cooling. According to Winkler, cod-liver 
oil does not yield glycerine, but oxide of propyl, when saponified. 

There are three varieties of oil, due, not to differences in composi- 
tion, but to modes of preparation : the pale, the light-brown, and the 
dark oil. The pale oil is freest from the products of decomposition and 
empyreuma, and is the best for internal administration. 

In order to obtain more positive therapeutical results, certain medi- 
cinal substances are frequently added artificially to the cod-liver oils of 
commerce. Iodine, bromine, phosphorus, and iron, are thus added. 
Not only are such compounds bad, chemically considered, but the addi- 
tion of such ingredients gives great opportunities for sophistication, and 
impure brown and other fish-oils may be substituted for the pure cod- 
liver oil. 

It has been supposed that any oil or fat, even- glycerine, may be 
used in place of cod-liver oil, and cream has been prescribed in this 
belief. Linseed-oil has been considered to have some special efficacy in 
wasting diseases, more particularly in phthisis, because of the large 
amount of vegetable albumen which it contains. These notions are er- 



OILS AND FATS. 97 

roneous. Cod-liver oil has special therapeutical virtues because it con- 
tains gachiin, propylamine, the constituents of bile, iodine, phosphorus, 
bromine, etc., in addition to the ordinarj' ingredients of an animal fat. 

Physiological Actions. — An oil or fat applied by friction to the 
epidermis will disappear, and, as a positive gain may thus accrue, it is 
reasonable to suppose that not only absorption, but assimilation, also, 
has taken place. 

Fat plays an important part in the metamorphosis of animal fluids. 
As was long since shown by Lehmann, a small quantity of fat is essen- 
tial to the digestion of nitrogenous articles of food. Cod-liver oil, as 
well as other 'oils, when taken in the proper quantity, has the power to 
facilitate gastric digestion, and therefore promotes the appetite. Oil 
is a very important material in intestinal digestion — constitutes the 
molecular basis of the chyle, which consists chiefly of finely-divided 
fatty matter, each globule of fat being surrounded by a thin layer of 
albumen. The fat taken in with the food undergoes the emulsionizing 
process, chiefly in the small intestine, and by the aid of the pancreatic 
and biliary secretions. Cod-liver oil is, above all other fats, adapted to 
form the molecular basis of the chjde. All fats do not penetrate into 
the veins and lacteals with the same facility, and the presence of certain 
substances is necessary to the process. Fats are not crystalloidal but 
colloidal substances, and have, therefore, but a feeble power of osmosis • 
but, notwithstanding this fact, the blood of the portal vein is much 
richer in fat than the blood of the arteries and systemic veins. The 
osmose of fats is accomplished by the action of the bile. It was long 
since shown, by Wistinghausen, that in capillary tubes moistened by 
bile, oil will rise much higher than in tubes not so moistened, or when 
moistened with water or a saline solution. He also showed that oil 
will pass through membrane saturated with bile much more readily than 
through similar membrane saturated with water. It has been as- 
certained that, in dogs with biliary fistulae, the amount of fat in the 
chyle is much below the normal, and in the fasces much greater than 
normal (Day). Hence it must be concluded that the presence of bile is 
necessary to the absorption of fats, and that cod-liver oil must be pecu- 
liarly adapted to form the molecular basis of the chyle. It is for these 
reasons that, during a course of cod-liver oil, the body-weight is in- 
creased, the red blood-globules become more numerous, and a greater 
amount of fat is deposited in the tissues. It promotes the constructive 
metamorphosis. The important role performed by the oils and fats in 
the organism is shown by a variety of considerations. Wherever tissue- 
changes, physiological or pathological, are taking place, fat accumulates 
and enters largely into the formation of the resulting products. Newly- 
formed plasma contains much free fat, and all plastic exudations more 
than the non-plastic (Lehmann). Fat is the most abundant constituent 
of pus. 



98 RESTORATIVE AGENTS. 

Food is intended ultimately for two objects : first, to build up the 
tissues in the growing state and to reconstruct the tissues wasted by 
use ; second, to supply force, nervous, muscular, and digestive, to the 
different parts of the organism requiring it. The part performed by the 
fats is important as regards both objects. As already stated, they are 
essential to the construction of tissue ; modern researches have shown 
that thev have a necessary office in the evolution of force. The well- 
known experiment of Fick and "Wislicenus demonstrated that, on a diet 
of hydro-carbons, great muscular effort can be undergone with but little 
destruction of muscular tissue, and without increased urea-discharge. 
Turkish porters, who are remarkable for their great muscular strength 
and endurance, live on a diet composed of fat and rice. The acrobats 
of Japan, who live on a similar diet, grow to an enormous size, and ac- 
complish feats of strength and agility to which the athletes of Western 
nations are hardly equal. 

If a muscle is made to contract under a bell-jar, an extraordinary 
evolution of carbonic-acid gas takes place, just as in violent muscular 
exercise the amount of carbonic-acid gas exhaled from the lungs is 
increased. 

Theeapy. — Oils and fats are used by inunction in the treatment of 
the scaly skin-diseases. In this case, the normal amount of oil in the 
skin being deficient, it is supplied artificially. 

Inunctions of oil or fat promote constructive metamorphosis in such 
chronic wasting diseases as phthisis, scrofula, chronic dysentery, etc. 
The best oil for this purpose is cod-liver oil, but, as it stains the skin 
yellow and has a disagreeable odor, it is often strongly objected to. 
Sevum or suet may be used and may be perfumed to the taste of the 
patient. The best time for practising the inunctions is just before re- 
tiring. A warm bath should first be taken, and then from one to two 
ounces may be rubbed into the skin. A thick night-garment should be 
put on to prevent injury to the bedding. 

Sadly-nourished infants, rickety, or scrofulous, or suffering from 
chronic intestinal disorders, who have a dry and scaly skin, are often 
materially benefited by the tepid or warm bath, followed by inunctions 
of lard, suet, or almond-oil. Chlorotic girls, with or without disorders 
of menstruation, are improved in condition by the same means. Spare 
women, who wish to gain flesh and roundness of form, may have their 
wish gratified hy warm baths and inunctions of oil. The improvement 
which results from this practice is partly due to the general gain in 
bodily nutrition. 

Rubeola, scarlatina, roseola, erysipelas, and other febrile diseases, 
are benefited by oil inunctions. These applications are grateful to 
the patient ; they allay the burning heat of the skin, and in this 
way diminish restlessness and excitement. It is said that inunctions 
of oil reduce the temperature, but the decline in fever-heat is prob- 



OILS AND FATS. 99 

ably the result of the calmative influence which these applications have 
over one of the chief sources of distress. Inunctions of oil have a 
special utility in the desquamative stage of scarlet fever. It is the 
author's observation that inunctions of oil are serviceable in fevers 
generally, when there is much heat of skin and high temperature, with 
restlessness. Cocoa-butter is the most elegant of these preparations 
for external use. In the infectious diseases, a little carbolic acid may 
be added to the inunction oil or fat, with the view of destroying dis- 
ease-germs. 

Those who experience frequent catarrhal attacks, and take cold on 
slight exposure, may have their susceptibility diminished by a daily 
application of oil to the whole surface of the body. 

In many maladies, the patients experience a notable distaste for 
fatty food in any form. This is especially the case with scrofulous and 
phthisical subjects, and, as fat in some form is necessary to digestion, 
assimilation, and heat-producing, it is obvious that by the use of cod- 
liver oil an essential element of nutrition may be supplied in the best 
form. In cases in which there exists a condition of faulty assimilation 
of fats, cod-hVer oil, by reason of the fact that it contains in intimate 
association the bile elements, is especially adapted to form the molecular 
basis of the chyle. In scrofula, rickets, and other disorders of the nutri- 
tive functions belonging to this group, cod-liver oil is the best remedy 
for promoting constructive metamorphosis. 

After scarlet fever in many children, especially in those with stru- 
mous diathesis, there occur discharges from the nose and ears, feeble 
digestion, and general emaciation. These sequela; of scarlet fever are 
best removed by the internal use of cod-liver oiL 

As a remedy in phthisis, cod-liver oil holds the first place, but it is 
not adapted to all forms and all stages of that disease. It is especially a 
remedy for the chronic forms of phthisis — -fibroid lung and chronic tuber- 
culosis — and is not serviceable in caseous pneumonia and acute phthisis. 
It is more useful in the chronic forms of phthisis because these afford the 
time and opportunity to reconstruct the tissues of the body — to build up 
the tissues from the molecular basis of the chyle. Cod-liver oil is not 
well borne when there is much fever, and cannot be well assimilated 
when the stomach has undergone the alterations which belong to acute 
inflammatory affections. This remedy is too often prescribed without 
any reference to the condition of the patient's digestive functions. The 
power of the stomach and intestines to digest fat is limited, and, if the 
quantity which can be disposed of is exceeded, the patient is incom- 
moded. Rarely is it proper to prescribe more than a teaspoonful three 
times a day, and few patients can digest a tablespoonful. As the secre- 
tion of gastric juice, bile, and pancreatic juice, takes place most abun- 
dantly during the digestion of food, the time for the administration of 
oil in phthisical cases is after eating. "When it is not well borne, the 



100 RESTORATIVE AGENTS. 

digestion and assimilation of the oil may be aided by combining it with 
liquor potassse, lime-water, the compound tincture of gentian, tincture 
of nux-vomica, or strychnia, or other correctives according to the indi- 
cations in individual cases. When tbe oil is not well digested — although 
stomach disorder may not have occurred — and it is seen to float on the 
stools, it may be combined with ether, since Bernard has demonstrated 
that ether increases the production of pancreatic fluid. 

If continued for a sufficient length of time, cod-liver oil is of the 
greatest service in chronic bronchitis and emphysema. It should be 
given in the same way and under the same conditions as in phthisis. 

Chronic rheumatism and rheumatic arthritis, maladies for the relief 
of which cod-liver oil was first prescribed, when occurring under bad 
hygienic influences in cachectic subjects, may be much relieved by this 
agent. In addition to the internal use of the oil, it may be applied with 
advantage locally to the affected joints. This combined use of the oil, 
systemically and by local inunction, is to be commended in the so-called 
rheumatic gout with deposits about the joints. On the same principle, 
cod-liver oil is beneficial in cases of strumous synovitis, caries, and ne- 
crosis of bone dependent on a constitutional state. It does not have, it 
must be admitted, any direct influence over these morbid processes ; 
but it enters most usefully into constructive tissue-metamorphosis. 

As a reconstituent, cod-liver oil is a very useful remedy in certain 
chronic affections of the brain and nervous system. One of the most 
common conditions with which we have to deal in middle and advanced 
life, and also one of the most important as regards the integrity of the 
brain, is atheroma of the arteries. This condition is represented by 
increased hardness of the radial pulse, the arcus senilis, irregular action 
of the heart, giddiness, vertigo, partial loss of vision, and failure of the 
memory and other intellectual faculties. Used to obviate these degen- 
erative changes, and to prevent failure in the nutrition of the brain, we 
have in cod-liver oil a remedy of real value. It should be given in small 
quantity, and continued for a long time. As a phosphorized fat plays 
an important part in the structure and functions of the cerebral tissues 
we may imitate the processes of Nature and administer the phosphates 
the hypophosphites, or the lacto-phosphate of lime, in combination with 
cod-liver oil. The author has seen excellent results from such a com- 
bined use of these agents. Dr. Anstie much insists on the use of fats 
especially cod-liver oil, as a part of the diet of those suffering from 
neuralgia, paralysis agitans, epilepsy, mercurial tremor, and chorea, 
Dr. Radcliffe had previously pointed out the utility of fats and oils in 
the same affections, and all practical physicians familiar with the sub- 
ject are now pretty well agreed as to the value of this practice. The 
special indications for cod-liver oil in these affections are faulty assimila- 
tion and a low condition of the nutritive functions. Fats and oils are, 
of course, contraindicated in these nervous disorders when they occut 



OILS AND FATS. 101 

in plethoric and over-fed subjects, but such a state of things is excep- 
tional. 

In diseases of the slcin of strumous origin, cod-liver oil is, as Dr. 
Tilbury Fox remarks, " our sheet-anchor." Among these diseases are 
lupus, ecthyma, psoriasis, scleroderma, etc. The constitutional state 
requiring cod-liver oil is a lowered condition of the assimilative func- 
tions dependent on the strumous cachexia. The local use of the oil is 
certainly advantageous in these cases. Dr. Hughes Bennett strongly 
recommends the free application of the oil to favus and eczema im- 
petiginodes. 

The condition of debility and faulty assimilation which results from 
the prolonged treatment of syphilis with mercury and iodine is frequent- 
ly remarkably improved by cod-liver oil. The syphilodermata, when 
occurring in cachectic subjects, are benefited by a persistent use of the 
same remedy. With the internal use of the oil may be conjoined in- 
unctions. These are especially beneficial in the squamos of syphilitic 
origin. 

Mode op Administration op Cod-Liver Oil. — As cod-liver oil is 
extremely repugnant to many patients, it is desirable to prescribe it in 
as agreeable a form as possible. Washing out the mouth with raw 
whiskey or brandy so far blunts the sensibility of the nerves as to permit 
the oil to be swallowed without difficulty as regards its taste. Quickly 
stirred up in a hot whiskey-punch, it may be swallowed without appre- 
ciation of the taste of the oil. It may be taken on beer, the oil covered 
with the foam, and carefully prevented touching the glass. A wine- 
glass may be thoroughly moistened with ale or beer, and the dose of 
oil just enveloped in the beer, when it may be tossed into the throat 
without perceiving the taste of the oil ; or the oil may be taken in 
sufficient lemon-juice in the same way. It may also be taken in black 
coffee. A very good disguise is that of Carlo Paresi, by which it is made 
to have the odor and taste of coffee. To 400 parts of cod-liver oil are 
added 10 parts of animal charcoal, and 20 parts of ground roasted coffee. 
The mixture is digested in a water-bath at a temperature of 50° to 60° 
C. and after standing three days is filtered and put in well-stoppered 
bottles. It is said that 10 drops of chloroform to 100 grammes of the 
oil will render it palatable. One part of essential oil of Eucalyptus to 
100 parts of pale oil makes a mixture in which the odor and taste of 
the oil are entirely extinguished. Two drachms of cod-liver oil may be 
mixed with "a drachm each of compound spirits of lavender and brandy. 
Emulsions of cod-liver oil are now prepared with glycerine and yolks 
of eggs and suitably flavored. The various emulsions with lime are also 
much prescribed. Cod-liver oil saponified by lime has been brought 
forward by Prof. Van den Court, of Brussels, as a remedy of especial 
efficacy in phthisis. Lastly, cod-liver oil has been used instead of lard 
or butter in the preparation of rolls, which are readily eaten by children. 



102 RESTORATIVE AGENTS. 

The addition of ether to cod-liver oil promotes its digestion. Ber- 
nard long ago made the observation that ether stimulates the pancreas 
and increases its secretion, thus contributing to the emulsionizing the 
fats. The combination of ether and cod-liver oil has been especially 
urged by Dr. B. Foster. The committee of the New York Thera- 
peutical Society report that the addition of fifteen minims of ether 
to each half -ounce of oil enables the patient to take it, if it had j>re- 
viously disagreed. 

Authorities referred to : 

Anstie, Dr. Francis E. Neuralgia and the Diseases that resemble it, Macmillan k Co., 
London, 18*71. 

Bennett, Dr. J. Hughes. Oleum Jecoris Aselli as a Therapeutic Agent in Certain 
Forms of Gout, Rheumatism, and Scrofula, London, 1841. 

Day, Dr. George E. Chemistry in its Relation to Physiology and Medicine, London, 
1860, p. 1?4. 

Flint, Dr. Austin, Jr. The Physiology of Man, vol. ii., p. 372, New York, 1878. 

Gubler, Dr. Adolph. Comrnentaires Therapculique, etc., Paris, 1868, p. 156. 

Lehmann, Prof. C. G. Physiological Chemistry, Philadelphia, 1855, vol. i., p. 221 
et seq. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittcl, Berlin, 1870, p. 661, et seq. 

Ranee, Prof. Dr. Johannes. G-rundzuge des Physiologie des Menschen, Leipzig, 1872, 
p. 289. 

Ringer, Dr. Sidney. Handbook of Therapeutics, p. 247. 

Simon, Dr. Franz. Animal Chemistry, Syd. Soc, vol. i., p. 206. 

Trousseau et Pidoux. Trait'e de T herapeuiique ct de Matlire Medicale, huitieme edi- 
tion, vol. i., p. 304. 

Williams, Dr. J. C. B. and Dr. Theodore. Consumption. 

Wood and Bache. IT. S. Dispensatory, thirteenth edition. 

PHOSPHORUS AND SOME OF ITS COMPOUNDS. 

Phosphorus. — Phosphore, Fr. ; Phosphor, Ger. A translucent, 
nearly colorless solid, resembling wax, without taste, but having a pe- 
culiar smell. Its specific gravity is 1.8. 

Oleum Phosphoratum. — Phosphorus twelve grains, almond-oil one 
ounce. Dose, five to ten drops in mucilage. An oleum phosphoratum 
is also prepared by dissolving, by the aid of heat, a half-grain of phos- 
phorus in four ounces of cod-liver oil. The dose of this preparation 
is one teaspoonful. 

Pilulce Phosphori. — Phosphorus one part, suet 100 parts. Three- 
grain pills. (Radcliffe.) 

Tinctura Phosphori. — Phosphorus one grain, absolute alcohol five 
drachms, glycerine one ounce and a half, spirit of wine two drachms, 
spirit of peppermint two scruples. " Dissolve the phosphorus in the 
alcohol with a little heat ; at the same time warm the spirit and glyce- 
rine together. Mix the two solutions while hot, and add the spirit of 
peppermint on cooling. Dose one-half to one drachm." 



PHOSPHORUS. 103 

Tinctnra Phosphori JEtherealis. — Solution of phosphorus in ether. 
Dose five to ten drops in sirup. A solution of phosphorus in chloro- 
form, or bisulphide of carbon, may also be prepared for internal ad- 
ministration. Pills of phosphorus may be extemporaneously made by 
mixing the bisulphide of carbon solution with some inert powder. 
The evaporation of the bisulphide leaves the phosphorus in a finely- 
divided state intimately incorporated with the powder. 

Zinci Phosphidum. — Phosphide of zinc. Dose one-twentieth to 
one-tenth of a grain. It is best administered in pill-form made with 
conserve of roses. 

Synergists. — Oils and fats favor the absorption of phosphorus, and 
should never, therefore, be employed in cases of poisoning by this 
agent. Arsenic, and in a feeble degree sulphur, are synergistic. 

Antagonists. — The chief chemical antidotes to phosphorus are 
hydrated magnesia, lime-water, powdered charcoal, and sulphate of 
copper. To this list must be added turpentine of a certain kind. 
Phosphorus is now frequently taken in the form of matches, the par- 
ticles of which do not readily dissolve in the stomach and intestinal 
juices. When pure phosphorus, in the sticks or cylinders in which it 
occurs in commerce, is swallowed, large masses may remain imbedded 
in the folds of mucous membrane, or, escaping solution, descend with 
the other contents of the canal. Considerable time may thus elapse 
from the ingestion of the poison until its action begins. Emetics, 
therefore, assume a high degree of importance, and the most service- 
able emetic is sulphate of copper, which is at the same time a chemical 
antidote (Eulenburg and Guttmann). Bamberger has shown that 
phosphorus reduces sulphate of copper to the metallic state, the first 
step in the process being the formation of phosphide of copper, and 
that the masses of phosphorus are surrounded by a layer of copper, 
preventing its evaporation. He, therefore, advises that an emetic dose 
of sulphate of copper be first administered. Emesis may be facilitated 
by giving hydrated magnesia, diffused in a quantity of tepid water. 
As catharsis is next in importance, the bowels should be thoroughly 
evacuated. After the emetic dose of sulphate of copper has acted 
efficiently, this antidote should be given in small doses as frequently 
as possible — about one-twelfth of a grain every twenty minutes. As 
the irritability of the stomach may prevent sufficient retention of the 
sulphate, the carbonate of copper has been proposed as a substitute, 
although Eulenburg and Landois, in their experiments on animals, have 
been unable, by the exhibition of the latter, to prevent death in cases 
of phosphorus-poisoning. 

Unquestionably the most important chemical antidote is turpentine, 
the French acid turpentine, especially. Letheby was the first to note 
that the vapor of turpentine prevented the toxic action of the vapor 
of phosphorus, and that workmen employed in the match-factory at 



104 RESTORATIVE AGENTS. 

Stafford, who were protected by vials of turpentine worn about the 
neck, escaped necrosis of the maxillary bones and other deleterious 
effects. Dr. P. C. Andant next published cases indicating the anti- 
dotal power of turpentine, and M. Personne submitted the subject to 
experimental demonstration and confirmed the observations of Andant. 
As turpentine destroys the luminosity in the dark and arrests the es- 
cape of the vapor of phosphorus, M. Personne infers that it acts simi- 
larly as an antidote, that is, prevents the combustion of phosphorus in 
the blood and the consequent consumption of the oxygen. The author 
has collected forty-six cases of poisoning by phosphorus, in which tur- 
pentine was employed as the antidote, and of this number but four 
were unsuccessful (Kohler, Sorbets, Laboulbene, Schimpff, Lichten- 
stein, Rommeleare, Berthold, etc.). Rectified oil of turpentine is not 
antidotal. The acid French oil is the preparation which has been 
used with success. The experiments of Vetter on animals fully con- 
firm the results of clinical experience, for he found that, while the 
rectified oil of turpentine had no effect, the crude, acid, French tur- 
pentine was very efficient as an antidote. The action of the crude 
turpentine is a process of oxidation and combination by which phos- 
phorus is converted into phosphoro-terebinthinic acid — a spermaceti- 
like substance, without poisonous or irritating qualities, which is elim- 
inated by the kidneys, the urine having a camphoraceous instead of 
the violet odor due to turpentine itself. Although the crude French 
oil is to be preferred, it is probable that our common oil of turpentine, 
exposed to the air, will develop antidotal power, by absorbing and 
ozonizing oxygen. The vapor of turpentine acts in the same manner 
on the vapor of phosphorus. The change in the effects of phosphorus 
acted on by turpentine has been thoroughly worked out. Admin- 
istered to dogs, from one to fifteen grains, this substance excited no 
nausea, did not impair the appetite, caused no change in the tissues, 
and was eliminated harmlessly by the kidneys. 

To sum up : In the treatment of poisoning by phosphorus, in any 
of the forms in which it is introduced into the stomach, an emetic 
of sulphate of copper should be promptly employed, and the bowels 
should be moved by hydrated magnesia. When the stomach is emp- 
tied, small doses of sulphate of copper may be administered, but pref- 
erably turpentine, which should be given as rapidly as possibly in an 
emulsion of gum, carefully avoiding oil. To counteract the cardiac 
and general systemic depression, opium will become necessary. If 
phosphorus has entered the blood despite the use of the appropriate 
antidotes, and much injury to its corpuscular elements has resulted, 
transfusion can be employed with considerable confidence, since Jiir- 
gensen has succeeded in several instances in saving life by this expedi- 
ent. Direct transfusion of human blood, with or without previous with- 
drawal of some portion of the damaged blood, is the proper procedure. 



PHOSPHORUS. 105 

Physiological Actions. — The vapor of phosphorus is highly irri- 
tating to the conjunctiva and to the broncho-pulmonary mucous mem- 
brane. If caries of the teeth exist, necrosis of the maxillary bones 
may be induced by the vapor ; but it is doubtful whether, as has been 
affirmed, such necrosis may occur when the teeth are perfectly sound. 
There is an obvious distinction between the local effects of the vapor 
of phosphorus and the disease of the osseous system, the result of the 
constitutional impression of this agent. 

In ordinary medicinal doses, jmosphorus gives rise to a sense of 
warmth at the ejjigastrium, but if the dose be large, decided heat and 
even burning are experienced, and tenderness of the epigastrium re- 
mains. Prolonged administration of full doses will excite considerable 
gastric disturbance, and a catarrhal state of the mucous membrane. In 
the process of the oxidation of phosphorus, hydrogen is evolved, which 
in its nascent state readily combines with a portion of phosphorus, 
forming phosphide of hydrogen, eructations of which constitute one of 
the disagreeable features in the administration of this remedy. The 
action of the heart becomes more frequent, and the cutaneous circu- 
lation, especially, more rapid ; the body temperature rises somewhat ; 
the mental activity and the muscular power increase ; the menstrual 
flow grows more abundant, and in males aphrodisiac effects are experi- 
enced, and the urine and sweat are more abundantly excreted. Phos- 
phorus promotes the constructive metamorphosis ; it increases the 
activity of the organs of vegetative life, and is a natural excitant of 
the functions of animal life ; it enters largely into the formation of 
tissues, and is a necessary element in the phosphorized fat which holds 
an important position in the composition of the cerebral matter. The 
administration of phosphorus increases the excretion of urinary phos- 
phates. 

The effects of phosphorus in toxic doses have been elaborately stud- 
ied, both in fatal cases of poisoning, occurring in man, and by experi- 
ments on animals. The form in which it is swallowed affects the rate 
at which the action occurs. If taken in solution in oil, in ether, or in 
the paste used as a vermin-destroyer, the toxic symptoms appear more 
promptly than if match-heads or ordinary phosphorus has been swal- 
lowed. An interval of varying duration elapses from the ingestion of 
the poison until disturbance of the stomach ensues. This interval — 
one to three hours — is occupied by the solution and oxidation of the 
phosphorus. Then epigastric uneasiness, nausea, and vomiting, come 
on; first, the contents of the stomach, and then mucus and bilious mat- 
ters being ejected. The vomiting, accompanied by considerable epi- 
gastric pain and tenderness, persists usually for several days, when it 
assumes a special character, owing to the presence of the so-called 
"coffee-grounds," or "black -vomit/' At first the vomited matters 
have a distinct odor of phosphorus, and appear phosphorescent in the 



106 RESTORATIVE AGENTS. 

dark. After several days of vomiting these symptoms disappear, and 
there may then be more or less hsematemesis, as well as coffee-grounds, 
due to erosions of the mucous membrane (Wolfe). The condition of 
the intestines varies with the presence or absence of phosphorus in 
their contents. The stools may be simply pasty and grayish from the 
absence of bile, or they may contain mucus and blood, and appear 
phosphorescent in the dark. Accordingly, as they may or may not be 
irritated, will the symptoms be those of constipation, diarrhoea, or dys- 
entery. The very characteristic but not invariable symptom — jaundice 
— appears on the second to the fifth day after the reception of the 
poison. It is absent in one-fourth of the cases, and may be absent, 
also, when there is considerable fatty degeneration of the liver {Wolfe, 
Alter). It presents the usual appearance of jaundice as it occurs in 
acute yellow atrophy. It does not attain the maximum at once, but 
it appears first as some yellowness of the conjunctiva, the urine also 
becoming dark and loaded with urates, at the same time. 

The chemical changes which phosphorus undergoes in the stomach, 
and the combinations by which it enters the blood, are as yet not fully 
explicable. That some phosphoric acid and phosphide of hydrogen 
are formed is certain. That the oil or fat in the stomach will dissolve 
some portion of the phosphorus, and thus facilitate its diffusion as 
phosphorus into the blood, is highly probable (Husemann and Marine). 
Phosphorus is also slightly soluble in water at about 100° Fahr., and 
in organic fluids, as the bile, to a greater extent (Hartmann). As in 
the oxidation of phosphorus, phosphorous and phosphoric acids, and 
phosphide of hydrogen, are products, it is certain that these exert a 
poisonous influence to a greater or less extent in the stomach (Lecor- 
che). A portion of the agent taken undoubtedly enters the blood as 
phosphorus, and the subsequent changes in tissue-metamorphosis are 
due to its presence in the blood, where it has been detected by Bam- 
berger and others. With the entrance of the poison into the blood 
the action of the heart increases, and the temperature rises, the fever 
having a remittent type (Mannkopff). Toward the end, however, the 
function of hrematosis and of tissue-metamorphosis are so depressed 
that the body-heat declines below normal. In other cases there is no 
fever at all, or it appears near the end. Yery great weakness of the 
heart's action has usually been observed, and the pulse has been much 
accelerated, although in some instances it became very slow, descend- 
ing as low as 40. The damage done to the blood is shown in the 
hemorrhages which take place from the various mucous surfaces — from 
the nose, stomach, intestines, kidneys, uterus (menorrhagia and me- 
trorrhagia) — and into the areolar tissue, in the form of petechia and 
ecchymoses. A hemorrhagic diathesis develops, so that the bleeding 
from a simple wound, a leech-bite, etc., may become uncontrollable. 

The intellect may remain unimpaired, but usually there are restless- 



PHOSPHORUS. 107 

ness with coma, sometimes noisy delirium, anesthesia of the extremi- 
ties, paresis of the members, and, near the end, convulsions (Hermann). 

Tbe poison entering the blood is eliminated chiefly by the kidneys. 
The changes occurring in the urine are of especial interest. No de- 
parture from the normal occurs until the alterations in the composition 
of the blood, and the general steatosis, prepare the way. The urine is 
diminished in amount, contains albumen, blood, and sometimes fibrin- 
ous casts. When jaundice comes on, its appearance is first announced 
by the presence of bile-pigments and acids. Urea almost entirely dis- 
appears toward the fatal termination ; leucine and tyrosine are occa- 
sionally present, and a peptone-like substance ; but the peculiarity most 
distinctive is the large quantity of parabiotic acid, especially in the 
fatal cases (Schultzen and Riess). 

The duration of the cases of phosphorus-poisoning is by no means 
uniform. Although the rule is that symptoms do not follow immedi- 
ately on the entrance of the poison into the stomach, there are cases 
in which pain, nausea, and vomiting, do occur almost immediately, 
and the most formidable symptoms come on promptly. One case is 
reported in which death occurred within nine hours, and numerous 
cases have terminated in death at the expiration of forty-eight to 
seventy-two hours. But usually the cases are less acute, and death 
does not occur before the end of the first, second, or third week. It is 
important to bear in mind that death may take place unexpectedly, 
before the most severe symptoms manifest themselves (Naunyn); and 
that the absence of decided gastric disturbance does not necessarily in- 
dicate a mild case. When recovery takes place, the improvement is 
slow, and the duration more or less protracted. In cases observed by 
Schultzen, the swelling of the liver could be distinguished at the ex- 
piration of four weeks, although the jaundice and the haemorrhages 
had disappeared. 

The changes induced by phosphorus are eminently characteristic. 
In the stomach are found erosions of variable extent, often absent ; 
fatty degeneration of the epithelium ; and a gastro-adenitis, first de- 
scribed by Virchow, and confirmed by subsequent observers, notably 
by Bernhardt, whence the membrane has a swollen, grayish, or yellow- 
ish color. The same state of the mucous membrane may exist in the 
intestine as well. The liver is much enlarged as a rule, but may be 
atrophied. In five of the sixteen cases studied by Wolfe the liver was 
atrophied, but this is probably a more advanced change, and is, there- 
fore, encountered in the most protracted cases. The color of the liver 
is usually a pale yellow, or it may present a deep yellow, the acini ap- 
pearing enlarged and distinct. The increased size of the organ and 
the change in its appearance are due to fatty degeneration of the he- 
patic cells and epithelium (Mannkopff) ; but, according to some other 
authorities, an interstitial hepatitis is also set up, which is especially 



108 RESTORATIVE AGENTS. 

well marked in chronic phosphorus-poisoning. The jaundice, it is 
agreed generally, is due to resorption of the bile, swelling of the bile- 
ducts and of the orifice of the ductus communis preventing the en- 
trance of the bile into the intestine. The presence of bile-pigments 
and acids in the urine supports this view, but it has also been main- 
tained that the jaundice is hasmotogenic from dissolution of the blood. 

The changes in the composition of the blood are numerous and im- 
portant : it is fluid, non-coagulable, its corpuscles altered in form, and 
it contains much fat (Mehu). There are numerous ecchymoses es- 
pecially under the peri- and endo-cardium (noted in thirteen out of six- 
teen cases by Wolfe), under the capsule of the liver, and in other 
situations. Besides the alterations in the blood, the occurrence of 
ecchymoses is favored by fatty degeneration of the small blood-vessels 
and capillaries (Klebs). The heart is also the seat of an acute fatty 
degeneration, and its tissue is soft and easily torn. The spleen is en- 
larged, and the kidneys are also enlarged and fatty, the renal epithe- 
lium being crowded with oil-drops. 

Not every case exhibits the wide-spread changes above described. 
If death occur in a short time, within nine hours, as has been noted, 
not sufficient time will have elapsed to allow of universal steatosis. 
There may, indeed, be no characteristic morbid appearances under such 
circumstances. In other cases, the changes may be limited to the liver. 

Chronic poisoning by phosphorus presents some interesting features. 
It occurs in those who are exposed to the vapor, in workmen engaged 
in phosphorus-factories, and especially in the workers in match-factories. 
Irritation of the bronchial mucous membrane, and to a less extent of 
the gastro-intestinal, takes place, with the attendant symptoms of 
cough, loss of appetite, indigestion, constipation, failure of nutrition, 
etc. The most important change is that occurring in the maxilla, more 
especially in the inferior maxilla, which is both more severely and more 
frequently diseased. The lower jaw has been repeatedly removed for 
this phosphorus necrosis, which begins in carious teeth, develops into 
a periostitis, and ends in death of the bone. The alveolar process only, 
or a part or the whole of the bone, may be cast off. Phosphorus in- 
creases the production of osseous tissue ; the spongy tissue is thickened, 
and the compact is rendered more dense. Extensive osteophytie forma- 
tions take place in animals fed on it, and the marrow cavity of long 
bones may be much encroached on, even closed, by the deposit of new 
osseous material (Wegner). 

Thekapy. — The author enjoins on his readers the necessity for cau- 
tion in the use of phosphorus. As this agent so readily induces an 
acute fatty degeneration, when taken in poisonous quantity, the pro- 
priety of its administration in large doses for long periods may well be 
questioned. 

Phosphorus, occupying an important position as an agent utilized in 



PHOSPHORUS. 109 

the constructive metamorphosis, may properly be prescribed when the 
nutritive functions are deficient in activity. It is especially in nutri- 
tive failure of the osseous and nervous tissue that phosphorus is re- 
quired. The original suggestion by Wegner of its probable utility in 
osteomalacia, or softening of bones, has been acted on by Friese, who 
found it remarkably beneficial in some obstinate cases. It will be found 
useful, also, when this condition exists in rickets. That hitherto incu- 
rable malady — progressive pernicious ancemia — has in some instances 
been apparently arrested by the administration of phosphorus ; but it 
has failed in others. Further investigations are needed. 

The physiological action of phosphorus in small doses in increasing 
mental activity finds a therapeutical expression in the use of its prep- 
arations in cerebral disorders. It is indicated in pathological states 
dependent on anaemia, and contraindicated in vascular congestion and 
excitement. Cases of wakefulness, dependent on cerebral anaemia 
and exhaustion, are often i*emarkably benefited by phosphorus in the 
form of the pill or tincture. It does not procure sleep in the way that 
chloral and bromide of potassium do. By the use of it in suitable 
states we supply to the cerebral substance a material which it requires 
for the healthy performance of its functions. It acts most beneficially 
in the cases of wakefulness in which the nutritive functions of the 
body are wanting in activity. The wakefulness of the aged, accom- 
panied with muscular cramps, feebleness of memory, giddiness and 
trembling of the voluntary muscles on exertion, is improved by the 
preparations of phosphorus. Early decay of the mental powers, asso- 
ciated with atheromatous changes of the cerebral vessels, and conse- 
quent impaired nutrition of the brain, is benefited by minute doses of 
this agent. In these states, occurring in the aged, it is better to com- 
bine with the phosphorus, or to administer simultaneously, cod-liver 
oil. The author has seen good results from such a combination in 
p>aralysis agitans. Large doses of the medicine in these disorders of 
advanced life are improper and unsafe. The best results are obtained 
from the persistent use of minute doses. M. Delpech has obtained 
excellent results from the use of phosphorus in £>arafo/s2s. It is ob- 
viously adapted to cases of chronic character in which all acute symp- 
toms have subsided. The paralytic symptoms Avhich accompany white 
softening of the brain (local and circumscribed aneemia) have appeared 
to the author to be improved by the use of the phosphates, hypophos- 
phites, and lacto-phosphate of lime. 

The preparations of phosphorus are very serviceable in neuralgia. 
It is true Dr. Anstie, in his recent able work on nem-algia, expresses 
the opinion that "its utility is not very extensive or reliable." Rad- 
cliffe, Bradley, Broadbent, Mr. J. Ashburton Thompson, on the other 
hand, report cures in some obstinate cases. Mr. Thompson's experi- 
ence indicates that large doses are necessary to effect a cure. In his 



HO RESTORATIVE AGENTS. 

own words : " I now invariably begin by giving ^ of a grain every 
four hours, and this I conclude to be an average dose." The formula 
given under the title "Tinctura Phosphori" is Mr. Thompson's ; each 
drachm of it contains T V of a grain of phosphorus. "With this solution 
he has treated successfully thirteen cases of neuralgia. Dr. Broadbent 
has given phosphorus with advantage in " epileptiform vertigo," neu- 
ralgia, and " nervous breakdown from overwork." 

We have no remedy at present more efficient in the treatment of 
impotence than phosphorus. In the physiological state, priapism is 
one of the results of its toxic action. It is, of course, adapted only 
to cases functional in character, and not to impotence from organic 
defect. 

According to Dujardin-Beaumetz, phosphorus is useful in that very 
protracted and troublesome disease, progressive locomotor ataxia, or 
posterior spinal sclerosis. Although the author has not observed any 
instances of cure of this affection by phosphorus, he has witnessed in 
a few instances decided amelioration. 

Phosphorus has lately been employed as a substitute for arsenic in 
the skin-diseases for which the latter is used — notably acne, psoriasis, 
lupus. The author has seen excellent results from the use of the com- 
pound sirup of the hypophosphites in acne indurata. 

Authorities referred to in this article : 

Alter, W. Experimcntelle Bcitrcige uber die Ursachen des deterus bci Phosphorver- 
giflung. Diss. Berolini. V. u. H., vol. i., 1867. 

Andant, Dr. P. E. Bull. Gen. de Therap., toine lxxv., p. 269. Ibid., tome lxxvi., 
p. 273. 

Anstie, Dr. F. E. Neuralgia and its Counterfeits, London, 1871. 

Bamberger, H. von. Wwrzbl. mcd. Ztschr., Band 7, 1. Full abstract in Virchow u. 
HirscKs Jahrcsbericht for 1867, vol. i. 

Bennett, Dr. James Risdon. The Medical Times and Gazette, vol. i., 1861, p. 438. 

Bernhardt, M. Die Verdnderungen des Magcns nach Phosphorvergiftung. Virchow's 
Archiv, Band 39, p. 23. 

Berthold, A. Arcliiv der Heilkunde, 1876, p. 258. 

Bradley, G. M. The British Medical Journal, October, 1872. 

Broadbent, Dr. W. II. The Practitioner, April, 1873, p. 230. 

Dusart, M. The Lancet, vol. ii., 1870, p. 122. 

Ebstein, Dr. Archiv der Heilkunde. Quoted in Schmidfs Jahrbuch., vol. cxiv., p. 283. 

Eulenburg and Landois. Die Transfusion bei acuten Phosphorvergift. Centralblatt. 
f. d. med. Wiss. Virchow u. HirscKs Jahresbericht, 1867, vol. i. 

Hartmann, Jul. Zur acuten Phosphorvergift. Diss. Dorpat. Ibid., vol. i., 1867. 

Hosemann, Th. and W. Marme. Ibid., vol. i., 1866. 

Kohler, H. Berlin, klin. Wochen., i., 1870, p. 5. Ibid., Wiener Prcsse, various num- 
bers, 1873. 

Laboulbene, Dr. Gaz. des Hopitaux, xlvi., 1879, p. 361, and Gaz. Hebdom., 1874, 
xxxiii., p. 524. 

Lecorche, Dr. Archives de Physiologie Norm, et Path., tome ii., 1869. 

Lebert, H. and Wtss, 0. Etudes cliniques et experimentales sur Vempoisonment aigu 



phosphorus, ill 

par le phosphor. Archives General de Medccine, September, October, November, and 
December, 1868. 

Munk und Leyden. Die acute Phosphorvergiftung, Berlin, 18G5. A. Ilirschwald. 

Personne, M. Bulletin General de Therapculique, tome lxxvi., p. 353. 

Radcliffe, Dr. C. B. The British Medical Journal, 1863, p. 489. 

Ranvier, Dr. L. Gaz. Med. de Paris, 27, 28, 1867. Pcchcrchcs cxperimcntalcs au 
sujet de Paction du phosphor sur la tissus vivants, etc. 

Rommalaere, Dr. Du Trailcmcnt de Vempoisonnement par le phosphore. Bull. Gen. 
de Therap., vol. Ixxxii., p. 145. 

Senftleden, Dr. Virchoio's Archil), vol. xxxvi., p. 530. 

Schraube, Dr. Otto. Ucbersicht neucr Mitthcilungcn tiber acute Phosphorvergiftung. 
SchmidVs Jahrbuchcr, Band 136, p. 207. 

Sorbets, Dr. Bull. Gen. de Therap., vol. lxvii., p. 42. 

Thompson, J. Ashburton. The Practitioner, vol. ii., p. 13. 

Vetter, Dr. A. Ucbcr die acute Phosphorvergiftung und deren Behandlung. Virchow' s 
Archiv, Band 53, p. 168. 

Virchow, R. Der Zusland des Mccgcns bci Phosphorvergiftung. Virclwio's Archiv, 
Band 31, p. 399. 

Wegner, Dr. Georg. Der Einfluss des Phosphors auf den Organismus. Ibid., Band 
55, p. 11. 

Wolfe, Jean. Disser. Berolini. Full Abstract in Virchow u. Hirscli's Jahrcsbericht, 
vol. i., 1868. An Account of the Morbid Appearances in Sixteen Cases of Phosphorus- 
Poisoning, occurring in Berlin from 1861 to 1868. 

PHOSPHITES AND PHOSPHATES. 

Preparations. — Comp. Syrup>us Calcii, Sodii, Potassii et Ferri 
Hypophosphitis. — Compound sirup of the hypophosphite of lime, soda, 
potash, and iron. Dose, a teaspoonful to a dessert-spoonful. 

Syrupits Calcii Zacto-phosphatis. — Sirup of the lacto-phosphate of 
lime. Dose, a teaspoonful. Lactic acid has the property of dissolving 
freshly-precipitated phosphate of lime. 

Compound Sirup of the Phosphates. — Parish's chemical food. 
Each drachm contains two and a half grains of phosphate of iron 
and one grain of phosphate of lime. 

Sodii Phosp>has. — Phosphate of soda. Dose, one drachm to one 
ounce. 

Sodii Pyrophosphas. — Pyrophosphate of soda. Dose, 3j-fss. 
The pyrophosphate differs from the phosphate, in that the water of 
crystallization is driven off by heat. It is usually preferred in the 
treatment of certain constitutional states, but for the intestinal and 
hepatic disorders in which these preparations are used there is little, 
if any, choice between them. 

Calcii Phosphas Prcecipitata. — Precipitated phosphate of lime. 
Dose, one to ten grains. 

Physiological Actions. — In the first edition of this work the^Aos- 
phates were included in the same section with phosphorus. There is 
a strong argument in favor of this arrangement, based on the chemical 
reactions which ensue when phosphorus is introduced into the stomach. 



112 RESTORATIVE AGENTS. 

Phosphorus has a strong affinity for oxygen, and compounds are quickly 
formed in the stomach. It is probable, however, that some phosphorus 
enters the blood uncombined. It is certain that the effects of phos- 
phorus differ in character from the effects of any of its compounds. 
They agree in the property of aiding constructive metamorphosis, but 
differ widely in other respects. 

Physiological Actions of Phosphate of Lime. — There is no part 
of the body which does not contain, or does not yield on incineration, 
phosphate of lime. It gives solidity to the osseous framework of the 
body, and, when too little is furnished during the growing period, rickets 
and mollities ossium are the result. The demand made on the system 
of the mother for the supply of this essential material for the growth 
of the osseous structure of the foetus is so great that her fractured 
bones unite with difficulty. The bones of animals, fed on food deficient 
in phosphate of lime, soften. All the animal fluids contain this sub- 
stance in solution : thus it is found in the blood, the saliva, the gastric 
juice, milk, urine, and in the intercellular fluid throughout the body. It 
accumulates wherever tissue-changes are rapidly taking place (Dusart). 
It is, obviously, very important to the nutritive processes of the body. 

As phosphate of lime is to a limited extent soluble in lactic and 
hydrochloric acids, it is evident that, administered by the stomach, 
diffusion into the blood must occur. Large amounts cannot, however, 
be disposed of in this way ; hence small doses must be as effective, in 
the treatment of the maladies for which it is prescribed, as large ones — 
for all in excess of the quantity soluble in the free acids of the stomach 
must pass off with the fasces or form intestinal concretions. 

Physiological Actions of Phosphate of Soda. — This salt is 
soluble in water in the proportion of four per cent. Hence it may be 
given in solution, and will readily diffuse through into the blood. In 
the dose of one ounce it acts as a laxative. As it has a saline taste 
similar to common salt, it may be given in soup or other food. It in- 
creases the alkalinity of the blood, according to Bocker, by causing a 
retention of the chloride of sodium. Phosphate of soda diminishes the 
excretion of urea, in part, it is supposed, by hindering the retrograde 
metamorphosis of tissue, in part by its interference with the process of 
digestion. It is a constituent of the blood in the normal state, and as it 
possesses the remarkable property of increasing the quantity of car- 
bonic acid which can be held in solution by any liquid, obviously we 
have in these facts an explanation of its influence over. the excretion 
of urea. That it impairs digestion in large doses when administered 
in health may be admitted, but by removing morbid states of the mu- 
cous membrane the digestive function, in suitable cases, is directly pro- 
moted by its use, and the nutrition* of the body generally, and the tone 
of the nervous system, improved. 

Therapy. — In cases of the so-called bilious sick headache, phosphate 



PHOSPHITES AND PHOSPHATES. 113 

of soda is a most useful laxative. A permanent cure of this very- 
troublesome malady may be wrought by regulation of the diet, and by 
the long-continued use of this remedy. It is not pretended that cases 
of migraine, due to an affection of the nucleus of the fifth, may be thus 
cured. A large proportion of these cases are produced by a catarrhal 
state of the gastro-intestinal mucous membrane, which the phosphate 
of soda has the power to remove. For the same reason, it is a remedy 
of the highest utility in cases of jaundice dependent on catarrh of the 
bile-ducts, this disease being secondary to the same process in the in- 
testinal mucous membrane. In these affections the phosphate of soda 
should be administered in a drachm-dose (about one teaspoonful) 
three times a day, or more frequently. Children, who are frequently 
subjects of this disorder, do not require larger doses than ten grains to 
a scruple. In preventing inspissation of the bile and crystallization of 
cholesterine, and attacks of hepatic colic, the persistent use of the phos- 
phate of soda is rarely unsuccessful. It is not pretended that this agent 
can relieve the attacks of hepatic colic, and, indeed, it is useless at these 
times. Many cases of this disease, if not most of them, originate in a 
catarrh of the duodenum, the transference of the catarrhal state by con- 
tiguity of tissue to the gall-bladder, and the formation of a nucleus of 
mucus and bile, about which the cholesterine crystallizes. Phosphate 
of soda has the property to prevent the occurrence of these changes, 
and consequently to prevent attacks of hepatic colic. The author has 
found one scruple to drachm doses, administered for several months be- 
fore each meal, extremely efficacious in a number of cases of this kind. 
The value of Vichy in this and kindred affections probably depends on 
the phosphate of soda contained in this mineral water. 

Many ill-conditioned children are found to pass pasty and white 
stools, showing the absence of bile, and are pale and ill-nourished not- 
withstanding an abundant supply of milk and a vigorous appetite. Ten 
grains of phosphate of soda, dissolved in the milk and given them sev- 
eral times each day, will often improve the intestinal digestion, change 
the appearance of the stools, and increase the nutrition of the body. 

The phosphates are especially useful in diseases characterized by 
mal-nutrition. In rickets, mollifies ossium, delayed union of fractures, 
early decay of the teeth in children, caries and necrosis of hone, in 
which the phosphate is needed to the repair and growth of the osseous 
structures, they may be supplied artificially. The phosphate of lime 
may be administered alone in these states, but is to be preferred in the 
form of the sirup of the lacto-phosphate, or of Parish's phosphates. As 
a large consumption of the phosphate of lime takes place during suck- 
ling, the anosmia of the nursing mother may be most advantageously 
treated with the lacto-phosphate of lime or phosphates. The waste 
caused by suppuration, carbuncles, mammary abscesses or boils, may 
be best repaired by the same means. The constitutional cachexia pro- 
9 



114 RESTORATIVE AGENTS. 

duced by chronic bronchitis with profuse expectoration, leucorrhoea 
and similar exhausting discharges, may be much improved by the phos- 
phates, and with the general improvement of the bodily state there 
usually takes place an arrest in the local morbid process. 

The explanation of the therapeutical action of the phosphates in the 
diseases just mentioned is equally true of their use in phthisis. The 
utility of the hypophosphites in this disease is not any greater, for it is 
probably true that these preparations undergo oxidation in the stomach 
and pass to phosphates. The compound sirup of the hypophosphites 
is an agreeable preparation and is readily taken, and certainly proves 
serviceable in the more chronic forms of the disease. The lacto-phos- 
phate, the phosphates, and the hypophosphites, are undoubtedly useful 
in chronic phthisis, fibroid lung, chronic tuberculosis, emphysema, and 
dilated bronchi, but no advantage can be expected from them in acute 
tuberculosis and caseous pneumonia. The utility of these preparations 
in these groups of maladies depends on their power to promote con- 
structive metamorphosis. If they improve the appetite, promote diges- 
tion, and increase the body -weight, they do good ; if they disagree with 
the stomach, they do harm (Bennett). Not unfrequently the sirup of 
the hypophosphites gives rise to distressing tormina. This may be 
obviated by combining with it dilute phosphoric acid — a combination 
very effective, therapeutically: I£. Syrp. hypophos. comp., 3 iijss, acid, 
phosphor, dil., f ss. M. S. A teaspoonful three times a day. Such a 
combination may be advantageously given with cod-liver oil, after meals, 
in chronic phthisis. The addition of arsenic contributes very materially 
to the therapeutical effects of the lacto-phosphate, for example: I£. 
Syrp. calcii lacto-phos., § iv; liq. potassii arsen., 3 j- M. S. A dessert- 
spoonful ter die. 

Late favorable reports regarding the curative effects of phosphorus 
and its compounds in pernicious anmmia have not been confirmed by 
the most recent experience. 

Percy, who has distinguished himself by researches on phosphorus, 
prepares hypophosphorous acid by passing through a solution of phos- 
phorus in oil, perfectly pure, and dry, oxygen. He maintains that hy- 
pophosphorous acid is the only preparation of phosphorus which should 
be employed in medicine. 

Further experience with the phosphate of soda justifies the author 
in the expression of his belief that it has the power to retard the 
growth of the changes known as sclerosis of the liver, and possibly, 
under favorable circumstances, to arrest them and to restore a com- 
paratively normal functional state. When, in obese subjects, a succes- 
sion of boils portends the development of diabetes, this remedy is 
highly useful. It has seemed very beneficial in the hepatic form of 
diabetes. No remedy is more effective in removing that condition of 
the system which produces furuncles, or boils. 



IRON. 115 

IRON AND ITS PREPARATIONS. 

Ferrum. — Fer, Fr. ; JEisen, Ger. 

Ferrum Medactum. — Reduced iron. Ferri pulvis. A tasteless pow- 
der of an iron-gray color. Dose, gr. ss — gr. ij. 

Ferri Subcarbonas. — Subcarbonate of iron. Precipitated carbonate 
of iron. A reddish-brown powder. Dose, gr. v — gr. xv. 

Trochisci Ferri Subcarbonatis. — Troches of subcarbonate of iron. 
Composition : Subcarbonate of iron, vanilla, sugar, and mucilage of 
tragacanth. Dose, one to five. 

Ferri Oxidum Hydratum. — Hydrated oxide of iron. Kept in the 
form of a soft magma and used as an antidote to arsenic. 

PUuIcb Ferri Composite. — Compound pills of iron. Composition : 
Myrrh, carbonate of sodium, sulphate of iron. Dose, one or two pills. 

Pilula Ferri Carbonatis. — Pill of carbonate of iron. Vallet's mass. 
Composition : Sulphate of iron, carbonate of sodium, clarified honey, 
sugar. Dose, gr. j — gr. v. 

Mistura Ferri Composita. — Compound mixture of iron. Compo- 
sition : Myrrh, sugar, carbonate of potassium, sulphate of iron, spirit 
of lavender, rose-water. Dose, a tablespoonful. 

Emplastrum Ferri. — Iron-plaster, strengthening-plaster. Compo- 
sition : Subcarbonate of iron, lead-plaster, and Burgundy pitch. 

Ferri Phosphas. — Phosphate of iron. A bright, slate-colored pow- 
der insoluble in water. Dose, gr. ij — gr. v. 

Ferri Pyrophosphas. — Pyrophosphate of iron. In apple-green 
scales, having an acidulous, slightly saline taste, and wholly soluble in 
water. Dose, gr. ij — gr. v. 

Ferri Sulphas. — Sulphate of iron. In transparent, bluish-green crys- 
tals, which, on exposure to the air, effloresce and change color. Is 
wholly soluble in water. Dose, gr. j — gr. iij. 

Ferri Sulphas Fxsieeata. — Dried sulphate of iron. A grayish- 
white powder, soluble in water with the exception of a small residue. 
Dose, gr. j— gr. ij. 

Liquor Ferri Subsulphatis. — Solution of subsulphate of iron. Mon- 
sel's solution. Composition: Sulphate of iron, sulphuric acid, nitric 
acid. An inodorous, sirupy liquid, of a ruby-red color, and of an ex- 
tremely astringent taste without causticity. It mixes with water and 
alcohol in all proportions without decomposition. 

• Liquor Ferri Tersidphatis. — Solution of tersulphate of iron. Com- 
position : same as preceding preparation, except the quantity of acid. A 
dark reddish-brown liquid, nearly devoid of odor, and of an acid and 
extremely styptic taste. 

Ferri Chloridum. — Chloride of iron. In orange-yellow, crystalline 
pieces, very deliquescent, and wholly soluble in water, alcohol, and ether. 
Dose, gr. j— gr. ij. 



HG RESTORATIVE AGENTS. 

Liquor Ferri Chloridi. — Solution of chloride of iron. 

Tinctura Ferri Chloridi. — Tincture of chloride of iron. Compo- 
sition : Solution of chloride of iron, alcohol. Dose, m. v — m. xx. 

Liquor Ferri Nitratis. — Solution of nitrate of iron. A transparent 
liquid, having a pale amber-color. Dose, m. ij — m. v. 

Syrupus Ferri Iodidi. — Sirup of iodide of iron. A transparent 
liquid of a pale-green color. Composition : Iodine, iron, sirup. Dose, 
m. x — m. lx. 

Pilulce Ferri Iodidi.— -Pills of iodide of iron. Composition : Iodine, 
iron, sugar, liquorice, and gum-arabic. Dose, one to three pills. 

Liquor Ferri Citratis. — Solution of citrate of iron. 

Ferri Citras. — Citrate of iron. Dose, gr. ij — gr. v. 

Ferri et Ammonii Citras. — Citrate of iron and ammonium. In 
garnet-red, translucent scales, having a slightly ferruginous taste, and 
readily and wholly soluble in water. Dose, gr. ij — gr. v. 

Ferri et Ammonii Sutyhas. — Sulphate of iron and ammonium. 
Ammonio-ferric alum. In octahedral crystals of a pale-violet color, 
soluble in one and a half part of water at 60°. Dose, gr. j — gr. ij. 

Ferri et Ammonii Tartras. — Tartrate of iron and ammonium. In 
transparent garnet-red scales, which have a saccharine taste. It is 
slowly soluble in rather more than its weight of water, but insoluble in 
alcohol and ether. Dose, gr. ij — gr. v. 

Ferri et Potassii Tartras. — Tartrate of iron and potassium. In 
transparent scales, of a dark ruby-red color, and wholly soluble in water. 
Dose, gr. ij — gr. v. 

Ferri et Quinice Citras. — Citrate of iron and quinia. In thin trans- 
parent scales, reddish or yellowish brown. Taste ferruginous and bitter. 
Slowly soluble in cold, more readily in hot water, and not soluble in al- 
cohol and ether. Dose, gr. j — gr. v. 

Ferri et Strychnine Citras. — Citrate of iron and strychnia. Contains 
one grain of strychnia to 100 grains of the compound. Dose, gr. j — gr. iij. 

Ferri Ferrocyanidum. — Ferro-cyanide of iron, Prussian blue. A 
tasteless powder of a rich, deep-blue color, and insoluble iu water. 
Dose, gr. iij — gr. v. 

Ferri Lactas. — Lactate of iron. In greenish-white crystalline crusts 
or grains, of a mild, sweetish, ferruginous taste, soluble in forty-eight 
parts of cold water, but insoluble in alcohol. Dose, gr. ij — gr. x. 

Ferri Oxalas. — Oxalate of iron; a lemon-yellow, crystalline pow- 
der insoluble in water. Dose, gr. ij — gr. v. 

Besides the official preparations of iron, there are numerous unoffi- 
cial formulae to which some attention must be paid. The following 
are the most meritorious of these : 

Ferri Arsenias. — Arseniate of iron. A tasteless powder of a green 
color, insoluble in water, but soluble in hydrochloric acid. Dose, gr. -fa 
— g r - h 



IRON. 117 

Syrupus Ferri et Manganesii Iodidi. — Sirup of the iodides of iron 
and manganese. Dose, 3 j. 

Mistura Ferri Aromatica. — Composition : Pale bark in powder, 4 ; 
calumba, in powder, 2 ; cloves, bruised, 1 ; iron-wire, 2 ; compound tinct- 
ure of cardamoms, 12; tincture of orange-peel, 2; peppermint-water, 
50 ; macerate the first four ingredients in the last one for three days, 
agitating occasionally, filter, add the tinctures, and make up to 50. 
Dose, §j — ij (Squire). 

Syrupus Ferri et Manganesii Pho$p>hatis. — Sirup of the phosphate 
of iron and manganese. Dose, 3 j. 

Mistura Ferri Laxans. — Composition : Sulphate of iron, 2 grains ; 
sulphate of magnesia, 1 drachm ; dilute sulphuric acid, 3 minims ; spirit 
of chloroform, 20 minims; peppermint-water to 1 oz. (Squire). 

Tinctura Ferri Acetat. ^Ftherea. — Ethereal tincture of the acetate 
of iron. Dose, m. x — 3 j. 

Ferrum Dialysatum. — Dialysed iron. This preparation is made 
by the process of diffusion, and is iron in the colloid state. It is odor- 
less, without the styptic taste of the ferruginous preparations, does not 
blacken the tongue and teeth, is free from irritant action, and does not 
constipate. It is precipitated by sulphuric acid, by acids, and by vari- 
ous salts, but neither alcohol nor sugar. It will no doubt prove to be 
the best form in which to administer iron. Dose, m. v — 3 i. 

If any given preparation has a styptic taste, and acts on the tongue 
and teeth, it is not genuine. 

Reduced iron is one of the most useful ferruginous preparations for 
internal administration, comparatively tasteless, and therefore easy of 
administration, and readily soluble in the juices of the stomach. The 
objection to its use is the occurrence of eructations, sulphuretted or 
phosphuretted, owing to the oxidation of the iron, the evolution of hy- 
drogen, and the combination of the nascent hydrogen with sulphur or 
phosphorus. 

The so-called subcarbonate of iron is really little more than the red 
oxide. In the official pilulae ferri carbonatis, the oxidation of the iron 
and the loss of carbonic acid are prevented by the sugar. This prepa- 
ration is very soluble in the stomach-juice and is readily assimilated. 
The troches of carbonate of iron are convenient for administration to 
children, who take them readily. The hydrated oxide of iron is solely 
used as the antidote to arsenic in solution. For remarks on its admin- 
istration I have to refer the reader to the article on Arsenic. Corre- 
sponding to these carbonates are the pilulae ferri compositse, which con- 
tain iron in the form of the carbonate, sulphate of soda, and myrrh. The 
mistura ferri composita is also a solution of the carbonate, contains 
myrrh and sulphate of potash, with a sufficient quantity of the latter to 
form an emulsion which suspends the iron. 

Of the phosphates the better preparation is the pyrophosphate, which 



118 RESTORATIVE AGENTS. 

is readily soluble, unirritating and easily assimilable. The sulphate is 
an active astringent, and is an efficient remedy. When prescribed in 
pillular form the dried sulphate should be used, as the sulphate in ef- 
florescing destroys the cohesion of the mass. Of the several solutions 
intended for topical use, the liquor ferri subsulphatis, or Monsel's solu- 
tion, is the best, as it is powerfully styptic without being corrosive. 
The tincture of the chloride of iron is most agreeably taken in the form 
of Oeuse's tasteless preparation, which appears to be an efficient cha- 
lybeate without possessing the causticity of the pharmaceutical prepara- 
tion. In the sirup of the iodide of iron and the sirup of the iodides 
of iron and manganese, sugar is used to prevent oxidation of the iron 
and the setting free of the iodine. In the iodide-of-iron pill the same 
result is obtained by sugar or gelatine coating. 

Less irritating to the stomach, but probably less efficient as ehalybe- 
ates, are the combinations of iron with vegetable acids. These may 
be administered dissolved in Rhine, Catawba, or sherry wine. An ele- 
gant mode of prescribing them is in effervescence — the citrates or tar- 
trates dissolved in a solution of citric or tartaric acid, and poured into a 
solution of sodium or potassium bicarbonate — to be drunk in efferves- 
cence. 

Antagonists and Incompatibles. — The carbonates are incompatible 
with acids and acidulous salts and vegetable astringents ; the citrates 
and tartrates with mineral acids, alkalies and their carbonates, tannic 
acid ; the iodides with acids, acidulous salts, alkalies and their carbonates, 
lime-water, vegetable astringents ; the tincture of the chloride, with 
alkalies and their carbonates, lime-water, carbonate of lime, magnesia 
and its carbonate, and astringent vegetables turn it black. 

Synergists. — All agents promoting constructive metamorphosis are 
synergistic to iron, especially animal aliment, the simple, aromatic, and 
astringent bitters, cinchona, manganese, bismuth, etc. 

Physiological Actions. — Although metallic iron is inert, yet in the 
stomach it enters into combination dissolved in the acids, and then ac- 
quires molecular activity. As a result of its oxidation in the stomach, 
hydrogen is liberated, which in its nascent state combines with sulphur, 
forming sulphuretted hydrogen. In part, iron is absorbed by the stom- 
ach, probably as an albuminate ; in part, in the intestinal canal. The 
stools under a course of iron become brownish and even black, a result 
which indicates that a part of the metal taken fails to be absorbed ; but, 
since it has been shown that, whether taken by the stomach or injected 
into the blood, elimination takes place by the intestinal canal, it re 
mains uncertain how much is excreted or is merely discharged unaltered 
in the fasces. 

Iron is not a substance foreign to the organism. Chemical analysis 
has demonstrated its constant presence in the blood, in the gastric 
juice, chyle, lymph, bile, in the pigment of the eye, and in traces 



IRON. 119 

in the milk and urine. According to Gorup-Basanez (analysis of C. 
Schmidt), the blood of man contains one part of iron to 230 of red 
globules, and that of beef one part of iron to 194 of red globules. Iron 
exists in combination in haematine ; according to some in the state of 
oxide, according to others as metallic iron. That it performs a very 
important office is shown in the rapid construction of red blood-glob- 
ules, when iron is administered in anaemia. Without it haematine is 
not formed, and the red globules diminish in number. By its medicinal 
use we furnish to the blood a material which it needs. In health a 
mixed diet contains sufficient iron for all the purposes of the economy. 
The blood being improved in quality by the administration of iron, the 
tissues are better nourished, and all the functions are performed with 
more vigor. 

The plvysiological action of iron is not limited merely to the construc- 
tion of red blood. When there is no intolerance to its presence in the 
stomach, it promotes the appetite and invigorates the digestion. By in- 
creasing the disposition for food and the ability to dispose of it, iron acts 
as a stomachic tonic. Hence, when given in the healthy state, or when 
administered for too long a period in disease, the gastric glands become 
exhausted by over-stimulation, and then it is said the iron disagrees. 
Being a restorative, its use is contraindicated in a condition of pleth- 
ora, especially when there exists a tendency to haemorrhage, or when 
there is reason to suspect an atheromatous state of the cerebral vessels. 

In large doses the soluble preparations of iron give rise to nausea and 
vomiting. Some of them possess more or less toxic activity ; the per- 
salts are more active than the proto-salts. The iodide and chloride, the 
nitrate and sulphate, are the most active, death having ensued from 
the tincture of the chloride in one case (Christison), and alarming symp- 
toms having occurred in others (Taylor). 

Certain of the salts of iron, the sulphates, the nitrates, the chlorides, 
possess a high degree of astringency. Hence they produce constipa- 
tion when taken internally. Brought into contact with blood, they co- 
agulate it, forming a tough, brownish magma ; and, as the albuminous 
elements of the tissues are also solidified, they are powerful haemostatics. 

Iron is eliminated by several channels. Its passage down the in- 
testinal canal and exit by this route have already been alluded to. As 
the experiments of Lussana have shown, a large part of the iron which 
enters the portal circulation is eliminated by the liver in the bile. On 
the other hand, the chief part of the iron which is made to enter the 
systemic circulation is eliminated by the kidneys. Much of that which 
is absorbed from the intestinal canal enters the capillary system of 
the liver, diffuses through into the bile, and but a small part finally 
enters the systemic circulation. 

The acid and astringent preparations of iron act on the teeth with con- 
siderable energy, as the experiments of Dr. Smith (of Edinburgh) prove. 



120 RESTORATIVE AGENTS. 

The tincture of the chloride and the sulphate are more corrosive 
than the wine, and of course are more injurious than the compounds of 
iron with the vegetable acids. 

Therapy. — Iron-spray — a weak solution of the liquor ferri subsul- 
phatis ( 3 j — 3 viij) — is very serviceable as an astringent in obstinate 
cases of epistaxis. The nozzle of the delivery-tube of the spray-douche 
should be inserted just within the anterior nares, and the spray be 
driven with considerable force. The same application is beneficial in 
chronic coryza, but the objection to its use is the danger of coloring 
the teeth. In pulmonary haemorrhage, the same application made to 
enter the throat with the inspired air will often arrest the flow of blood ; 
and this, notwithstanding so little iron can pass the chink of the glottis. 

The subsulphate and pernitrate solutions are the most efficient reme- 
dies for arresting haimatemesis. They should be given in small doses — 
one or two drops, well diluted with ice-water, and frequently. In the ab- 
sence of these, the tincture of the chloride may be used in the same way. 
In intestinal hemorrhage the astringent preparations of iron are much 
less beneficial, if, indeed, they serve any useful purpose — for they are con- 
verted into inert sulphides as they descend the canal. The author has 
seen the intestinal haemorrhage of typhoid fever much increased by the 
rectal injection of a solution of Monsel's salts. The bleeding from 
h&morrhoids may be much diminished and even arrested by washing 
the tumors, when they protrude, with the solution of the subsulphate. 
After the application of the iron, the tumors should be well oiled before 
returning them into the rectum. The solution of the pernitrate of iron 
has been very efficacious as an astringent in chronic diarrhoea and 
dysentery, in that known as the army diarrhoea. These diseases, as 
they occur in civil practice, may sometimes be arrested by this agent, 
but not usually, in the author's experience. A solution of the tincture 
of iron is one of the numerous remedies used to destroy the ascarides 
vermiculares — the thread-worms which infest the rectum. As the de- 
velopment of these parasites is favored by the anaemic state, it is good 
practice to conjoin with any local treatment the internal use of iron, 
notably the sirup of the iodide. 

Iron is frequently given with advantage to promote appetite and 
digestion merely. Indeed, it is the opinion of some eminent authori- 
ties that the chief use of iron as a remedy, even in anaemia, is to pro- 
mote the digestive function. For the purpose of increasing appetite 
and energizing digestion, the sulphate is the best chalybeate, unless, 
indeed, the mucous membrane prove intolerant. When digestion is 
feeble, and the intestinal movements sluggish, it is often advantageous 
to combine aloes with iron, as in the official aloes-and-iron pill, or with 
sulphate of magnesia, as in the mistura ferri laxans, the formula for 
which has been given. 

The condition most usually requiring iron is anaemia, a deficiency 



IRON. 121 

not only of the hsematine but of the red corpuscles. Iron is given in 
this state with the view of supplying to the organism a material in 
which it is deficient, and in this way promoting the construction of the 
red globules. As, however, food, especially beef, is rich in iron, and as 
but a small amount of that administered is really assimilated, there is 
much reason for holding that at least an important function of iron in 
anaemia consists in its power to promote appetite and digestion. Prac- 
tical physicians are familiar with the fact that iron improves but little, 
if at all, the condition of the anaemic, when it does not increase the 
desire for food and the ability to digest it. In anaemia, iron is given 
with two objects : to furnish a needed material to the blood ; to increase 
the energy of the primary assimilation. To accomplish the first object, 
Bmall doses — one or two grains — of reduced iron or of the carbonates, 
or some one of the combinations with vegetable acids, are most suitable. 
The second object is best attained by the more active astringent prep- 
arations, especially the sulphate and the chloride. Large doses of 
these are frequently well borne. When they disagree, other salts may 
be tried, but preference should be given to the most astringent prepara- 
tion which the patient's stomach will tolerate. 

In chlorosis, the good effects of iron are not so conspicuous as in 
anasmia, although they are allied states. During a course of iron in 
chlorosis, purgatives are now and then necessary. Better results are 
obtained from a combination of iron and arsenic, and iron and strychnia, 
than from iron alone. The arseniate of iron is an excellent remedy in 
chlorosis, but it must be given in larger doses than the posological 
tables authorize, for it is by no means so actively toxic as is commonly 
supposed. A good formula is the following: IjL Ferri arseniat., gr. 
ij ; ext. cinchonae, gr. xij. M. ft. pil. no. xij. Sig. One three times 
a day after meals. 

In anaemia and chlorosis, the iron should be taken after meals to be 
mixed with the food. The preparations of iron should not be continued 
too long ; occasional intermissions in their use are necessary, otherwise 
the digestive organs become deranged, and the good effects are lost. 
Occasional purgation is useful, and acts in a way to favor the absorption 
and assimilation of the iron. Air and exercise should always, if prac- 
ticable, be prescribed in a ferruginous course, for the assimilation of iron 
is directly favored by these hygienic influences. 

The anosmia of chronic malarial poisoning is especially improved 
by iron. If enlargement of the spleen and engorgement of the portal 
circulation coexist, the use of the compound jalap-powder should pre- 
cede the iron ; or the latter may be combined advantageously with resin 
of podophyllin, as follows : Tfr . Chinoidin, 3 ij ; resinae podcphylli, 
gr. iv; ferri sulphatis exsic, 3j. M. ft. pil. no. xx. Sig. One three 
times a day. 

According to some, the pil. ferri carbonatis is preferable to the 



122 RESTORATIVE AGENTS. 

sulphate; it is certainly sometimes better borne. $. Pil. ferri carbo- 
natis, 3j; acidi arseniosi, gr. j; quinise sulph., 3ij. M. ft. pil. no. 
xl. Sig. Two pills three times a day. In enlarged spleen of malarial 
origin, a combination of sulphate of iron with sulphate of quinine is 
generally preferred. $. Quinioe sulphat., 3j; ferri sulphat. exsic, 
3 jss. M. ft. pil. no. xxx. Sig. One pill three times a day, or four or 
five during the day. 

Although the preparations of iron are of little service in leucocy- 
thcemia, they are certainly in a high degree useful in pseudo-leucocy- 
thaimia, or cachexia of the spleen. In the latter disease the relative 
number of blood-corpuscles may be greatly reduced, but they can be 
increased in number and raised to the normal by the use of those 
materials needed by the blood-making organs, especially by the use of 
iron. 

In syphilitic cachexia, the preparations of the iodide of iron possess 
a high degree of utility. In sloughing phagedena, or simple chancroid, 
the iodide, is frequently prescribed when these accidents occur in debili- 
tated constitutions. Some authorities prefer the tartrate of iron under 
these circumstances, but the iodide acts with more promptness and 
vigor. In the treatment of constitutional syphilis, the ferruginous prep- 
arations are only useful in so far as they may be applied to promote con- 
structive metamorphosis. More commonly than is supposed by the 
advocates of special plans of treatment, tonic remedies, especially cha- 
lybeates, exercise a most favorable influence over the course and dura- 
tion of syphilis. IjL Iodoformi, 3 j ; hydrargyri chloridi corrosiv., gr. j; 
ferri redact!, 3j. M. ft. pil. no. xx. Sig. One pill three times a da}-. 
I£. Iodoformi, chinoidin, ferri redacti, aa 3j. M. ft. pil. no. xx. Sig. 
One pill three times a day. 

Iron is one of the remedies most useful in the treatment of acute 
rheumatism. As was originally suggested by Reynolds, the tincture of 
the chloride is most serviceable. It is more especially adapted to the 
treatment of pale, delicate, and cachectic subjects, and is much less 
beneficial if not positively harmful, in the plethoric and overfed. Given 
in suitable cases, the tincture of iron, in doses of in. xx — xxx every four 
hours, diminishes the pain, fever, and sweats, lessens the chances of car- 
diac mischief, and hastens convalescence. By retarding waste and 
favoring excretion of uric acid through the kidneys, the duration of the 
disease is shortened and a tedious convalescence is prevented. TTe 
owe to Dr. Anstie the important suggestion that tincture of chloride of 
iron may be used successfully as a prophylactic against acute rheuma- 
tism. Here, again,- the author must state, as a result of his personal 
observation, that such prophylactic treatment is very useful in weak 
and cachectic subjects and not applicable to the robust and full-blooded. 
The tincture of iron should be administered without delay in such weak 
subjects with a rheumatic history, when they complain of lassitude, 



IRON. 123 

muscular pains, sore joints, furred tongue, although they are yet free 
from fever and joint-swellings. 

The treatment of erysipelas by large doses (m. x — 3 j every four 
hours) of tincture of chloride of iron is now very generally adopted. It 
is questionable whether this practice is directly beneficial. Its utility 
depends chiefly on the support which it affords to the organism while 
laboring under a debilitating disease, and, as an abundant supply of ali- 
ment is prescribed with the iron, it is impossible to estimate in any given 
case how far the result may be attributable to the remedy. 

Influenced by the same considerations, the tincture of iron is fre- 
quently prescribed in diphtheria, alone or in combination with chlorate 
of potassa. Although it possesses no special utility in this disease, it 
may serve as one of the means for maintaining the forces of the body, 
and in this way indirectly contribute to a favorable result. There is no 
advantage in applying the tincture of iron to the fauces in diphtheria ; it 
Is not a solvent of the false membrane, and cannot prevent the spread of 
the exudation. 

In the treatment of scrofula, strumous enlargement of the cervical, 
inguinal, and mesenteric glands, and in rickets, the preparations of iron 
occupy a most important place. In these affections the sirup of the 
Iodide of iron is generally preferred, and excellent results are obtained 
from a combination of phosphate of iron and phosphate of lime, espe- 
cially in rickets. In these cases, also, the sirup of the iodides of iron 
and manganese is indicated. Iron is one of the remedies most fre- 
quently prescribed in chronic tuberculosis, but it has no special influence 
over the deposition of tubercle. It helps to a better state of the blood- 
making process, and, by promoting the constructive metamorphosis, hin- 
ders the progress of the malady. 

As neuralgia so often depends on anaemia, it happens that iron is 
one cf the most frequently prescribed remedies for this disease. Anstie 
prefers large doses (m. xxx — xl ter die) of the tincture of the chloride, 
and 20-grain doses of the saccharated carbonate twice or three times a 
day. 

In disorders of the mind, either dependent on or increased by an 
anaemic state, iron is often useful. In chronic mania and melancholia, 
when debility is present, iron is employed as a restorative agent. The 
ferruginous preparations are especially useful in the anaemic forms of 
puerperal mania, and in the insanity of lactation. Bucknill and Tuke 
prefer the tincture of the chloride in these affections. 

Whenever epilepsy occurs in weak and anaemic subjects, iron is in- 
dicated. Cases of this disease, essential in character and dependent on 
cerebral anaemia, are sometimes cured by iron alone. The author has 
seen excellent results from a combination of bromide of iron and bromide 
of potassium in such cases : I> . Potassii bromidi, § j ; ferri bromidi, gr. 
iv ; aquae, § ij ; syrup, simplicis, § vj. M. Sig. A tablespoonful bis die. 



124 RESTORATIVE AGENTS. 

Large doses of subcarbonate of iron have long been used with ad- 
vantage in chorea. When the subject of this disease is distinctly anaem- 
ic, iron, in some of its forms, is unquestionably serviceable, and its 
utility is often increased by combination with purgatives. When anae- 
mia is not present, arsenic is preferable to iron. Chorea arising from 
moral causes (anger, fright, etc.), and from pregnancy, is not benefited 
by iron. This remedy is especially adapted to the chorea of anaemic 
girls about the age of puberty. 

The preparations of iron are of course inadmissible in acute affec- 
tions of the respiratory organs, but, in certain of the chronic forms and 
stages of these diseases, some of the chalybeates are very useful. In 
chronic bronchitis, with free expectoration, the mistura ferri com- 
posita has long been used with advantage. At the present time the 
phosphate of iron, quinia, and strychnia, is generally preferred in chronic 
bronchitis, in the chronic forms of phthisis, in emphysema, and in 
humid asthma. Iron is contraindicated when pulmonary haemorrhage 
exists or is threatened. A combination of tincture of digitalis and 
tincture of chloride of iron abates the temperature and diminishes the 
sweats of hectic fever. 1J, . Tinct. digitalis, 3 iij ; tinct. ferri chloridi, 
3 v. M. Sig. Fifteen drops three or four times a day. 

In fatty degeneration of the heart, the preparations of iron render 
important service, by improving the nutrition of the organ. The pal- 
pitations, the murmur, and prcecordial anxiety which accompany cases 
of anaemia and chlorosis, are relieved by chalybeate medicines. In 
dilatation of the cavities of the heart, especially the right, accompanied 
by cough, difficult breathing and general dropsy, greater relief is some- 
times experienced from the preparations of iron than by the so-called 
cardiac sedatives and diuretics. In these cases, as also in mitral re- 
gurgitation, the distress of the patient increases with increasing thin- 
ness of the blood, and is diminished by those remedies, such as iron, 
which improve the quality of the blood. A combination of iron, digi- 
talis, and squill, is sometimes extremely serviceable in these cases — 
for example : $. Ferri redacti, quiniae sulphat., pulv. digitalis (English), 
aa 3 j ; pulv. scillas, gr. x. M. ft. pil. no. xx. Sig. One pill three or 
four times a day. Iron may be used with advantage to assist in the 
process of compensation in valvular lesions, when the condition is one 
of anaemia. Iron is contraindicated in all cases of cardiac disease 
occurring in those who are full-blooded. 

In the passive forms of hemorrhage — in purpura, the hemorrhagic 
diathesis, epistaxis, gastric, intestinal, and renal haemorrhage, when 
they are due to anaemia or favored by it — iron is unquestionably useful, 
and the preparation most generally applicable is the tincture of the 
chloride. 

Derangements of the menstrual function, when associated with 
anaemia, more especially when produced by anaemia, are often removed 



IRON. 125 

by the use of chalybeate medicines. Amenorrhea is, more frequently 
than to any other cause, due to anaemia of the ovaries, consecutive to 
chlorosis or general anaemia, and dysmenorrhea may depend, in one of 
its forms at least, upon the same condition of the blood. Menorrhagia 
may also be one of the results of an impoverished state of the blood. 
Iron is the most appropriate medicament in these disorders. It is the 
judgment of Graily Hewitt and Barnes that " small doses of iron are 
generally the best" in amenorrhcea. Barnes prefers the solution of the 
acetate, and speaks favorably of the citrate of iron and ammonia, given 
in an effervescent state, and of the combination of iron and strychnia. 
The use of ferruginous preparations in menstrual disorders should be 
determined by the results of a careful differentiation of the causes. The 
absence of the uterus and ovaries, occlusion of the cervix, and various 
other conditions besides anaemia, should be eliminated, and the use of 
iron restricted to those cases in which an impoverished state of the 
blood is either the only factor or an influential one. 

The injection of the various styptic solutions of iron into the uterine 
cavity, to arrest post-partum haemorrhage, is now common practice. 
Notwithstanding the alleged innocuousness of this treatment, it ig 
probable, as Snow Beck has shown, that fatal results have ensued from 
the incautious use of these injections. The official solutions of the 
perchloride and subsulphate have been thrown into the uterine cavity, 
with the effect to cause uterine thrombosis, followed by systemic infec- 
tion. These solutions are much too strong; one part of Monsel's solu- 
tion to three of water is sufficiently styptic, and is probably perfectly 
safe. The uterine cavity should be cleared of clots, and the nozzle of 
the syringe carried well up to the fundus, when the injection should be 
slowly delivered. The reader need hardly be reminded that this expe- 
dient is only proper after the usual means for securing uterine con- 
tractions have failed. The same plan of styptic injections has been 
used to arrest the hemorrhage from abortion, but caution is necessary 
in these cases, for it is essential to safety that there be an open and 
patulous condition of the os, to permit escape of coagula. Similarly 
these injections are used to restrain bleeding in cases of uterine fibroids, 
uterine cancer, and in the uterine hemorrhage dependent on spongy 
granulation of the mucous membrane. In every case of such use of 
styptic iron injections, it is essential, first, that air be not pumped into 
the uterine cavity, and second, that sufficient dilatation of the cervical 
canal exist to permit ready exit to the surplus fluid and coagula. 

In albuminuria, connected with chronic changes of the kidney, iron 
is often very serviceable to improve the digestion, and to correct the 
anaemia, which is such an obvious feature of these maladies. The 
tincture of the chloride and the tincture of the acetate — especially the 
latter — are preferred, partly on account of their value as haematinio 
remedies, and partly because of their supposed diuretic action. When 



126 RESTORATIVE AGENTS. 

spermatorrhoea is dependent upon an impoverished condition of the 
blood, with relaxation of the vesiculse seminales, the tincture of iron is 
useful, but it is rarely of itself sufficient to effect a cure. The chalybe- 
ates are only harmful in those cases of nocturnal seminal losses which 
in the robust are merely significant of plethora. In gleet occurring in 
anaemic subjects, and in the prostorrhoea and catarrh of the urethra, 
which arise from relaxation, the preparations of iron are useful adjuncts 
to other measures. IjL Tinct. ferri chloridi, 3 vj ; tinct. cantharidis, 3 ij. 
M. Sig. Fifteen drops in water, three times a day. 

The sirup of iodide of iron is one of the most successful remedies 
in the nocturnal incontinence of urine in children. The precise indica- 
tions for its use are not evident. Sometimes belladonna succeeds bet- 
ter. It appears to the author that the iodide of iron is more useful 
in the case of pale, delicate, and strumous children, and belladonna, 
in those who are more robust, the condition in the former being one of 
atony of the muscular wall of the bladder, in the other too ready con- 
traction from the reflex stimulation of acid urine. In these cases of 
incontinence of urine the sirup of the iodide should be given in doses 
of fifteen to twenty minims, well diluted with water, three times a day. 

Local Uses. — The styptic preparations of iron are frequently used 
to restrain hemorrhage. Leech-bites that bleed too profusely, haemor- 
rhage after extraction of teeth or in minor surgical operations, oozing 
from a large wounded surface, may often be checked by the use of 
Monsel's solution. 

As a topical application in gonorrhoea after the acute symptoms 
have subsided, in mucoid cervicitis, in leucorrhoea, the styptic prepara- 
tions of iron are certainly useful, but a strong objection to their use arises 
from the staining of the clothing. 

Monsel's solution is an effective application to fissured nipples : ]£. 
Liquor ferri subsulphatis, 3 ij ; glycerini, 3 vj. M. Sig. Apply with a 
camel's-hair brush to affected parts. Pure solution of subsulphate of 
iron will arrest the growth and cause the exfoliation of syphilitic vege- 
tations of the glans and prepuce. 

Authorities referred to : 

Anstie, Dr. Fkancis E. Neuralgia and its Counterfeits, Macmillan & Co., London, 1871, 
p. 181. 

Barker, Dr. Fordtce. Puerperal Diseases, New York, 1874, p. 183. 

Barnes, Dr. Robert. A Clinical History of Diseases of Women, London, 1873, p. 
185. 

Bucknill and Toke. Manual of Psychological Medicine, third edition, London, 1874, 
p. 764. 

Christison, Dr. Robert. A Treatise on Poisons, Edinburgh, 1832, p. 573. 

Euxenburg, Dr. Albert. Lehrbuch der functionellen Nervcnkrankheiten, Berlin, 1871, 
pp. 71, 198, 448, etc. 

Gubler, Dr. A. Commentaires Therapeutiques du Codex Medicamentarius, Paris, 1868. 

Hewitt, Dr. Graily. Diseases of Women, second edition, London, 1868, p. 418. 



MANGANESE. 127 

Jahresbericht iiber die Fortschritte der Pharmacognosie, JPharinacie und Toxicologic, 
Gbttingen, 1872, p. 23V, art. Eisen. 

Ibidem, 1872, p. 523, Eisengehalt verschiedener vegetabilischer und thierischer Sub- 
stamen. 

Lussana, Prof, von Ph. Lo Sperimentale, October, 1872, Schmidt's Jahrbucher der 
gesammten Medicin, vol. clvi., p. 262. 

Notiinagel, Dr. Hermann. Handbuch der Arzneimiltellehre, Berlin, 1870, p. 411, et 
eeq. 

Pokrowsky, Dr. W. Vichovi's Archiv, vol. xxii. 

Squire, Peter. Companion to the British Pharmacopeia, eighth edition, London, 1871. 

Taylor, Dr. A. S. On Poisons, third English edition, 1875, p. 484. 

Trousseau et Pidoux. Traite de Therapeulique et de Matiere Medicate, huitieme Edi- 
tion, art. Fer. 

United States Dispensatory, thirteenth edition. 

Waldenburg und Simon. Handbuch der allgemeinen und speciellen Arzneiverord- 
nungs-Lehre, achte Auflage, 1873. 

Woronichin, Dr. N. Wien. med. Jahrbuch, xv., Schmidt's Jahrbucher der gesammten 
medicin, vol. exxxviii., p. 288. 



MANGANESIUM. 

Manganese. — Mangan, Ger. ; manganese, Fr. 

Manganesii Oxidum Nigrum. — Black oxide of manganese. Dose, 
gr. ij — gr. x. In pill or powder. 

Manganesii Sulphas. — Sulphate of manganese. In colorless or pale 
rose-colored transparent crystals, freely soluble in water. Dose, gr. ij — 
gr. v. 

Unofficial preparations : 

Syrupus Ferri et Manganesii Iodidi. — A pale straw-colored sirup. 
Dose, m. x — 3 ss. 

Ferri et Manganesii Garbonas Sacch. — A tasteless reddish-brown 
powder. Dose, gr. v — 3j. 

Syricpus Manganesii Iodidi. — A sirup which corresponds in strength 
to the official sirup of the iodide of iron and may be given in corre- 
sponding doses. 

Besides the above, a carbonate, phosphate, tartrate, malate, and lac- 
tate, have been proposed for use, but hitherto they have not attracted 
attention and are rarely employed. The official and unofficial prepa- 
rations named above are all that, according to the present state of pro- 
fessional experience on the subject, will ever be required. It will be 
most convenient, however, to include with the manganic preparations 
the following : 

PotasscB Permanganas. — Permanganate of Potassa. In needle- 
shaped crystals, of a deep-purple color. It is soluble in sixteen parts 
of cold water, and the solution has a deep-purple to a rose-color, accord- 
ing to the state of dilution of the salt. Dose, gr. ss — gr. j. In pre- 
scribing the permanganate, distilled water free from organic matter 
should be directed. 



128 RESTORATIVE AGENTS. 

Physiological Actions. — The sulphate has an extremely disagree- 
able styptic and metallic taste ; the black oxide less so, and the saccha- 
rated carbonate is free from any taste except that of the sugar. The 
preparations of manganese are somewhat irritant to the gastro-intesti- 
nal mucous membrane, and the sulphate is emeto-cathartic in full doses. 
There seems to be no doubt that the sulphate has a decided cholagogue 
effect, for very large discharge of bile is a result of its cathartic action. 
In small doses the manganic salts promote the appetite and digestive 
function. They probably enter the blood as albuminates. The intimate 
association of manganese with iron throughout the economy of Nature 
is exemplified in the human body. They are found together in the 
blood, hair, bile, biliary concretions, and renal calculi. The proportion 
of manganese to iron in the red blood-corpuscles is as one to twenty. 
As an essential constituent of the blood it undoubtedly has to do with 
the constructive metamorphosis of the body. Used in large doses and 
for a considerable period of time it produces effects analogous to those 
of zinc — progressive wasting and feebleness, a staggering gait and paral- 
ysis (paraplegia). In toxic doses, according to the researches of Lasch- 
kewitsch, it causes in animals death by convulsions. In smaller doses 
it diminishes the pulse-rate, lowers the action of the heart, and lessens 
the blood-pressure. Like phosphorus, manganese induces acute fatty 
degeneration of the liver. When it is injected into the veins of animals, 
it causes tetanic cramp, dilatation cf the pupil, exophthalmus, and death, 
and after death the heart-muscle does not respond to electrical stimula- 
tion (Laschkewitsch). 

Antagonists. — The preparations of manganese are not incompatible 
with the vegetable astringents. The salts of lead, silver, and mercury, 
and the caustic alkalies, are chemically incompatible with manganese. 

Synergists. — Iron is synergistic as regards haematinic effects, and 
the salts of copper, silver, and zinc, as regards the effects on the ner- 
vous sj'stem. 

Therapy. — Although manganese has not of itself been very useful 
in the treatment of anaemia and chlorosis, yet there is no doubt that its 
combination with iron much increases the efficacy of the latter. Some 
of the preparations named at the head of this article, especially the sac- 
charated carbonate of manganese and iron, may be usefully prescribed in 
these diseases. Cachectic states arising from syphilis, cancer, struma, 
gout, prolonged suppuration, chronic malarial infection, etc., are suc- 
cessfully treated by the sirup of the iodide of iron and manganese. 

Gastrodynia and pyrosis, according to Dr. Leared, are relieved by 
10 to 15 grain-doses of the black oxide — not the commercial article, but 
an oxide purified by washing with hydrochloric acid. In these disor- 
ders the effects of manganese are similar to those of bismuth (nitrate and 
carbonate), of zinc, and silver (oxide). Small doses of manganese (sul- 
phate) may be usefully combined with iron and quinine when prescribed 






MANGANESE. 129 

to promote constructive metamorphosis. IjL Quiniae sulph., ferri sulph. 
exsic, manganesii sulpb. exsic, aa 3j. M. ft. pil. no. xx. Sig. One 
pill three times a day. In jaundice of malarial origin, or from catarrh 
of the biliary passages, the author has seen excellent results from the 
use of manganese. I£. Chinoidin, 3j; manganesii sulph. exsic., 3ij. 
M. ft. pil. no. xx. Sig. One three times a day in malarial jaundice. 
$. Fel. bovin. purif., 3 j ; manganesii sulph. exsic, 2>ij ; resina? 
podophylli, gr. v. M. ft. pil. no. xx. Sig. One three times a day in 
catarrhal jaundice. In the disordered digestion of gouty subjects, and 
to restore the activity of the assimilative functions after attacks of gout, 
manganese is most serviceable. 

Manganese (chloride) has been used by Osborne with success in 
haemorrhage {epistaxis), and the sulphate is one of the remedies for 
chronic rheumatism, neuralgia, cholera, and syphilis. 

An ointment of the oxide ( 3 ij — § j adeps suil.) has been used with 
advantage in tinea, scabies, and other chronic shin-diseases. ■ I£ . Man- 
ganesii oxid., sulphuris, saponis dur., aa fj; adipis suilli, 5 iij. M. 
Ointment for porrigo. 

Actions and Uses of the Permanganate of Potassa. — This salt is a 
very powerful oxidizing agent, and yields up its oxj'gen readily in the 
form of ozone. Its use as an internal and external remedy is based en 
this chemical fact. That it parts with its oxygen so readily is held by 
some to demonstrate its entire inutility when administered by the stom- 
ach. Although it must instantly be decomposed on reaching the stomach, 
there are satisfactory reasons for believing that it exerts a favorable 
influence on certain diseases in which, theoretically considered, it may 
be indicated. The author has seen marked advantage from its use in the 
dyspepsia and flatulence so constantly attendant on obesity. It has 
also appeared to be very serviceable as a remedy for an abnormal and 
excessive deposition of fat. In the so-called uric acid diathesis it fa- 
vors the conversion of uric acid into urea, and thus prevents the forma- 
tion of uric-acid calculi. Pain in the lumbar region, frequent micturi- 
tion, acid urine, much brick-dust sediment, and intestinal indigestion, 
are associated symptoms relieved by the permanganate. Under the 
same conditions, it is probable, acute rheumatism is developed, and to 
the action of the permanganate as an oxidizing agent is attributable 
the benefit which is sometimes obtained from its use in this disease. 
In scarlatina and diphtheria the permanganate is used with undoubted 
benefit, applied to the throat and taken b} T the stomach. In erysipelas, 
puerperal fever, septicaemia, it has been given with advantage. It is 
indicated as an internal remedy in the septic morbid states, and is cer- 
tainly beneficial, whatever view may be entertained of its modus ope- 
randi. For internal use the permanganate is best administered in pure 
distilled water, and the bottle containing the solution should be glass- 
stoppered. The dose for internal use is gr. \ — gr. j ter die. 
10 



130 RESTORATIVE AGENTS. 

The most important uses of permanganate of potassa are external 
and disinfectant. It is a deodorizer rather than a disinfectant. It is 
very frequently used (3j — Oj) to correct the fetor of cancer, ulcers, 
caries, abscesses, etc. It is used as an injection, or in the form of spray, 
to destroy the odor of the discharges and to alter the morbid action, in 
cases of ozcena, otorrhoea, etc. It is an elegant toilet preparation (gr. 
j — | j) for destroying the odor of a foul breath, the smell of the axilla, 
and the fetor of the sweat of the feet. Its action is not lasting, and 
the effects must be maintained by frequent applications. 

The permanganate of potassa in solution (gr. ij — | j) is one of the 
numerous remedies prescribed in gonorrhoea and leucorrhoea, but it ha? 
no special advantages in these maladies. 

When the permanganate is deoxidized it loses its rich purple color, 
becomes a dull red, and is reduced to the state of binoxide of manga- 
nese. 

Authorities referred to : 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologie, Berlin, 1S74, p. 195. 

Laschkewitsch, W. Vergleichen.de Uniersuchungcn uber die Wirkung der Mangan- 
und Eisensalze. Medicinische Cerdralblatt, 1866, No. 24. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, fourth edition, Philadel- 
phia, 1874. 

Trousseau et Pidoux. Traile de Therapeutique et de Matiere Medicate, huitieme 
ddition, Paris, 1868, vol. i., p. 59. 

United States Dispensatory, thirteenth edition, p. 708. 

CHALYBEATE MINERAL SPRINGS. 
1. North American. 

Bailey Springs, Lauderdale County, Alabama. 

These springs contain carbonates of potassa, soda, magnesia, carbonic- 
acid gas, oxide of iron, etc. 

Rawley Springs, Rockingham County, Virginia. 

Carbonate of iron (0.203 grain) is the most important ingredient in 
these waters. They contain, also, carbonates of manganese, magnesia, 
lime, and lithia, and sulphates, etc. 

Sweet Chalybeate Springs, Alleghany County, Virginia. 

The name of this water is derived from its sweetish taste. It is 
highly charged with carbonic-acid gas, and contains sesquioxide of iron, 
with sulphate of lime (4.110 grains), sulphates of magnesia and soda, 
and chlorides of lime, sodium, magnesium, etc. 

Rockbridge Alum Springs, Rockbridge County, Virginia. 

Bath Alum, Bath County, Virginia. 

These waters are remarkable for containing free sulphuric acid. They 
contain also sulphates of magnesia and lime, protoxide of iron, and car- 
bonic-acid gas. The Bath Alum waters contain twice as much iron ai 
the Rockbridge Alum. 



CHALYBEATE SPRINGS. 131 

Bedford Alum Springs, Bedford County, Virginia. 

Similar in composition to the above, but contain a larger proportion 
of iron, and of the salts of potassa, magnesia, and lime. 

Bedford Springs, Bedford County, Pennsylvania. 

This water contains carbonate of iron (0.625 grains) associated with a 
large proportion of sulphate of magnesia (10 grains), and is, therefore, a 
laxative chalybeate. 

2. European. 

Bascombe, Bournemouth, Hampshire, England. 

Chalybeate springs containing carbonic acid in combination. 

Dorton, Buckinghamshire, England. 

Contains sulphate of iron and is charged with carbonic acid. Re- 
quires dilution for drinking. 

Hastings, Sussex, England. 

Contains sulphates of iron, magnesia, lime, and soda. 

Sandrock, Isle of Wight. 

Is a strong aluminous chalybeate : 41-j grains of sulphate of iron, and 
31-J grains of sulphate of alumina in 20 ounces, and therefore requires 
dilution for drinking. 

TlUlbridge, Kent, England. Altitude, 289' ; temperature, 50° Fahr. 

This water contains £th of a grain of iron with carbonic acid, in 
20 ounces. 

Spa, Belgium. Altitude, 1030'. Season, August and September. 
Temperature of water, 52° Fahr. 

These waters contain carbonates of iron, manganese, soda, lime, and 
magnesia, etc., and are highly charged with carbonic acid. 

Pyrniont, Waldeck. Altitude, 404' ; mean annual temperature, 48.5° 
Fahr. 

The quantity of carbonic-acid gas is unusually great in these waters. 
They contain sulphates of lime, soda, magnesia, and carbonates of iron, 
soda, magnesia, and lime. 

Alexisbad, near Harzgerode, Germany. 

Alexisbrunnen. Same. 

Both contain iron and manganese in large quantity, and also car- 
bonic-acid gas. The first named, being highly impregnated with chloride 
and sulphate of iron, is used for bathing, and the other for drinking. 

Schwalbach, Nassau. Altitude, 909'. Season, June to September. 
Temperature, 64° Fahr. 

According to the analysis of Fresenius, this valuable water contains 
bicarbonates of iron, manganese, soda, magnesia, and lime, sulphates of 
soda and potash, and chloride of sodium. It is very highly charged with 
carbonic acid. 

St. Moritz, Upper Engadin, Switzerland. Altitude, 5464'. Mean 
temperature of summer months, 51° Fahr. 



132 RESTORATIVE AGENTS. 

These springs contain from 10 to 14 grains of solids in a pint, consist- 
ing of carbonates of lime, magnesia, manganese, iron, and soda, etc., and 
as much as 39.5 cubic inches of carbonic acid. 

Therapy of Chalybeate Waters. — The uses of these waters are 
the same as the purely medicinal preparations of iron. They are indi- 
cated in chlorosis and anaemia, to supply to the blood the material in which 
it is deficient. For this purpose the milder waters, containing carbonate 
of iron and abundant carbonic acid, are most suitable; for example, in 
this country, Rawley Springs, Sweet Chalybeate, Bedford (Pennsyl- 
vania) ; in England, Bascombe and Tunbridge ; on the Continent, Pyr- 
mont, Spa, Schwalbach, St. Moritz. When passive hemorrhages — the 
hemorrhagic diathesis — require ferruginous waters, the alum and iron 
waters are more effective. Amenorrhoea, hysteria, and other pelvic 
disorders, when dependent on anasmia, the paludal cachexia, leucocy- 
themic-exophthalmic goitre, are either cured, or decidedly ameliorated by 
chalybeate waters. 

The purgative iron waters are useful in engorgement of the liver, 
haemorrhoids, and dyspepsia of anemic subjects, in albuminuria and 
dropsy ; the alum springs in chronic diarrhoea and strumous diseases. 

Neuralgia, chorea, cerebral anemia, and other nervous disorders 
due to an impoverished condition of the blood, are much improved by 
the use of the milder chalybeate waters. 

In making selection of a chalybeate water, the psychical influences 
of mountain scenery, or other pleasant surroundings, should not be dis- 
regarded. For the anaemic pulmonary invalid, elevation of the spring 
and the absence of humidity are important considerations to determine 
a selection. Hence, the present popularity of St. Moritz. In this 
country a great variety is afforded — mountain scenery like Bedford, 
Pennsylvania, and the Virginia springs, or rolling upland like Bailey's 
and Sharon. As respects composition, the ferruginous springs of the 
United States are equal to any in the world. 

Authorities referred to (see articles on Alkaline and Saline Springs). 



None of the remedies heretofore considered, contained in the group 
of agents promoting constructive metamorphosis, are foreign to the 
organism. They are all necessary to and directly promote the formation 
of the blood and tissues. 

In the same group, however, are remedies which, while they are 
tonic and reconstituent, do not enter into the composition of the body. 
They promote, in an indirect way, the constructive metamorphosis. 
Among these are bismuth, arsenic, the simple bitters, cinchona and its 
alkaloids. These agents having performed their office are, after a vari- 
able period, eliminated from the organism. Their therapeutical effects 
cannot be entirely comprehended in the process of "constructive meta- 



BISMUTH. 133 

morphosis, and in the ultimate results of their physiological actions the 
destructive metamorphosis may be included 

BISMUTHUM. 

Bismuth. — Bismuthi subcarbonas, sicbcarbonate of bismuth. A 
white or yellowish-white powder, without taste or smell, insoluble in 
water. Dose, gr. x — 3 j> in powder or emulsion. 

Bismuthi Subnitras. — Subnitrate of bismuth. A heavy, white pow- 
der, with a faintly acid odor and taste, insoluble in water. Dose, gr. x 
— 3 j, in powder or emulsion. 

Besides these official preparations, various compounds of bismuth 
are prescribed. None of these present any advantages over the .offici- 
al forms, and most of them are objectionable from various considera- 
tions. The solutions of bismuth do not produce the effects of the in- 
soluble subcarbonate and subnitrate, aud the various trade preparations 
containing bismuth and pepsin, bismuth and strychnia, bismuth and 
calisaya, etc., are, to the last degree, unscientific and unreliable. 

Physiologicat, Actions. — The insoluble preparations have a very 
slightly-metallic taste. They coat the tongue black by the formation 
of a sulphide. Given in suitable cases, they promote the appetite and 
increase the digestive power, and a gain in body-weight is one result of 
their administration. They are somewhat astringent, and retard the 
intestinal movements. As they are nearly insoluble, they pass down 
the intestinal tract and are converted into sulphides ; hence the faeces 
under their use become a dark-slate color. They are not entirely in- 
soluble, for bismuth can be detected in the blood, uriue, and other secre- 
tions, after a course of these medicines. Sufficient is absorbed under 
some circumstances, it is said, especially after prolonged administration, 
to cause toxic symptoms ; but such a result must be due to accidental 
combinations, or to the presence of arsenic, which is a very constant 
impurity in the ordinary commercial preparations of subnitrate and sub- 
carbonate of bismuth. Trousseau and Pidoux remark, with regard to 
its presumed toxic effects, as follows : " When the subnitrate of bismuth 
has been prepared from the perfectly pure metal, precipitated and well 
washed, it may be given in single doses from one to four grammes (fif- 
teen grains to a drachm) without producing the least malaise.'''* Ao 
cording to the same authority, Dr. Monneret has often given as much 
as ten to sixty grammes a day, without any recognized ill effects. It 
maj*, therefore, be concluded that the action of bismuth is chiefly local. 

Therapy. — In the aphthatoi children, nursing sore-mouth, the milder 
cases of mercurial salivation, and in those painful ulcers of the mucous 
membrane of the mouth due to disorders of digestion, bismuth applied 
freely to the affected parts is often very serviceable, by diminishing the 
pain and promoting the healing process. Bismuth allays the irritability 
of the mucous membrane in cases of acute indigestion, if given after the 



134 RESTORATIVE AGENTS. 

• > 

contents of the stomach are fully evacuated. It is especially indicated 

when there is not only painful digestion, but a tendency to diarrhoea, 
the inclination for stool coming on soon after the food has been taken. 
It is given with great advantage in subacute and chronic gastritis, and 
in gastralgia arising from a state of irritation of the gastric mucous 
membrane. It is contraindicated, and is not beneficial, in the gastral- 
gia produced by habitual constipation and in the gastralgia of chlorosis 
and hypochondria. The pain and vomiting attendant on gastric ulcer 
and scirrhus of the stomach are relieved by bismuth, and in the case 
of the former disease this remedy contributes to the cure. In these 
painful affections, the good effects of the bismuth are enhanced by com- 
bination with morphia. B. Bismuthi subnitrat., 3 ij ; morphia? sulphat. 
gr. j. M. ft. pulv. no. vj. Sig. One three times a day in milk. 
When morphia is, from any cause, inadmissible, hydrocyanic acid may 
be given in a mixture with bismuth. B- Bismuthi subnitrat., 3 ij ; 
acid, hydrocyan. dil., 3 ss ; mucilag. acacias, aquas menthas pip., aa 
§ ij. M. Sig. A tablespoonful three times a day. Although arsenic 
as an impurity is so objectionable that special pains are taken in the 
pharmaceutical process to separate it in the preparation of subnitrate, 
yet the author has witnessed excellent results from a combination of 
arsenic and bismuth in the more chronic stomach-disorders for w r hich 
the latter is prescribed. 

When bismuth is not well borne by the stomach, it may be combined 
with aromatic powder, or, when alkalies are indicated, it may be given 
with chalk or magnesia. When constipation is produced by it, bis- 
muth can be administered with rhubarb or magnesia. 

Bismuth is one of the remedies most frequently employed in the 
treatment of the vomiting of teething children, cholera infantum, and 
summer diarrhoea. Numerous combinations are employed : with pepsin, 
when these disorders appear to depend on the condition known as apep- 
sia, the discharges containing masses of undigested caseine ; with rhu- 
barb, when the symptoms are produced by undigested aliment, or when 
the stools are white and pasty ; with soda and chalk, when the stools are 
acid and excoriate the buttocks. In cases of vomiting of pregnancy, the 
vomiting of teething children, acidity, and pyrosis, excellent results are 
sometimes obtained from bismuth and carbolic acid. B- Bismuthi sub- 
nitrat., 3 ii ; acid, carbol., gr. ij — gr. iv ; mucil. acacias, 3 j ; aquas men- 
thas pip., § iij. M. Sig. A tablespoonful for adults and a proportion- 
ate quantity for children three or four times a day. 

The diarrhoea of typhoid fever is restrained by bismuth in scruple 
to half-drachm doses. In chronic diarrhoea large doses of bismuth are 
beneficial and often curative, but thirty to sixty grains must be given 
every three or four hours. Equally large doses check the diarrhoea of 
phthisis. In these doses bismuth not only restrains the intestinal dis 
charges, but improves the appetite and the digestion. 



ARSENIC. 135 

Bismuth is employed for a variety of purposes in the treatment of 
external maladies. It is a good application to the reddened surface of 
the skin in cases of acne rosacea, and may be used as a cosmetic in this 
mortifying disease. The author has seen excellent results from the 
free application of bismuth in cases of eczema when there was" much 
serous exudation. Under the crusts thus formed healing proceeded 
satisfactorily. In intertrigo and in the erythema which occurs about 
the genitals of infants, dusting the affected surface with bismuth soothes 
the pain and promotes healing. Bismuth is one of the numerous appli- 
cations to the eye in cases of chronic conjunctivitis and granular lids. 
It is also used as an injection, mixed with mucilage or with cocoa-bu1> 
ter in the form of a suppository, in chronic gonorrhoea and in gleet, and 
in leucorrhoea. IJ. Bismuthi subnitrat., gr. vj ; hydrarg. chlor. cor., gr. 
ss. ; tinct. campborae, m. jss ; aquas ad §j. M. Lotion for skin-diseases. 

The best vehicle for the administration of bismuth is milk. It 
should be given before meals as a rule when employed in stomach-dis- 
orders. 

Authorities referred to : 

Fox, Dr. Wilson. The Diseases of the Stomach, London, 1872, pp. 93, 94, 139, 179, 
203, etc. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimillellehre, Berlin, 1870, p. 297, 
e t seq. 

Squire. Companion to the British Pharmacopeia, eighth edition, p. 58. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, vol. i., p. 183. 

Trousseau et Pidoux. Trail'e de Therapeutique et de Matiere Medicate, vol. i., p. 
200. 

United States Dispensatory, thirteenth edition, p. 1062. 

Waldenburg und Simon. Handbuch der allgemcinen und speciellen Arzneiverordnungs- 
Lehre, Berlin, 1873, p. 195, et seq. 

ARSENICUM. 

Arsenic. — Acidivm arseniosum y arsenious acid ; acide arsenieux, 
Fr. ; Arsenige Saure, Ger. Dose, ■£$ — ^ grain. 

Arsenici lodidum. — Iodide of arsenic. Is an orange-red, crystal- 
line solid, entirely soluble in water, and wholly volatilized by heat. 
Dose, gr. ^. 

Liquor Arsenici Chloridi. — Solution of chloride of arsenic. Dose, 
m. ij— v. 

Liquor Arsenici et Hydrargyri Iodidi. — Solution of iodide of 
arsenic and mercury ; Donovan's solution. Dose, m. ij — v. 

Liquor Potassii Arsenitis. — Solution of arsenite of potassium ; 
Fowler's solution. (Arsenious acid, bicarbonate of potassium, com- 
pound spirit of lavender and distilled water.) Dose, m. ij — x. 

Liquor Sodii Arseniatis. — Solution of arseniate of sodium ; Pear- 
son's solution. Dose, m. ij — xx. 

Arsenic in solution is better for internal administration than the 



136 RESTORATIVE AGENTS. 

solid arsenious acid, and, of the three solutions (official) mentioned 
above, Fowler's is the best. Arsenious acid when administered in the 
solid form and at short intervals may act with unexpected violence. 

When a course of arsenic is begun, large doses should be prescribed, 
and the quantity administered should be regularly reduced. In this 
way chronic arsenical poisoning is avoided. When continually increas- 
ing doses are given, the arsenic accumulates, and toxic symptoms are 
quickly induced. As a rule, unless very small doses are prescribed, 
arsenic should be taken after meals. Some subjects are soon seriously 
affected by even small doses of arsenic. For this reason, when the idio- 
syncrasies of the patient are unknown, it were better to make tenta- 
tive experiments with a few small doses before beginning with large 
ones. A few drops of laudanum given with arsenic will enable it to be 
better borne by some susceptible subjects. 

Antagonists and Incompatibles. — The salts of iron, magnesia, 
and lime, and astringents, are chemically incompatible. The arseniate 
of iron, although not actively so, does cause toxic symptoms if con- 
tinued in full medicinal doses. The hydrated sesquioxide of iron, 
freshly precipitated, and in a soft magma, is the antidote to arsenic in 
solution. About eight grains of the antidote are required for each grain 
of the poison swallowed. As the hydrated sesquioxide of iron is harm- 
less, it should be given in teaspoonful to tablespoonful doses, every few 
minutes. In every case of poisoning by arsenic, prompt efforts to 
secure evacuation of the contents of the stomach are necessary. Large 
doses of the antidote may be given with the emetic employed. In the ab- 
sence of the hydrated sesquioxide of iron, magnesia, chalk, and lime-wa- 
ter may be given freely. These agents act in part, and probably chiefly, 
mechanically, by enveloping the particles of arsenic, and so hindering 
absorption. It is held by some that freshly precipitated hydrate of 
magnesia is more effective as an antidote than the hydrated sesquioxide 
of iron. Large draughts of oil, milk, and substances containing mucilage, 
by protecting the mucous membrane, render important service in cases 
of arsenical poisoning. Dialyzed iron, later experiences show, is quite 
as efficient as the hydrated sesquioxide, and is always ready. It is an 
important point to favor rapid elimination of the poison when the pa- 
tient survives the acute symptoms. This is accomplished by the use of 
diluent drinks, skimmed-milk, slightly alkaline mineral waters, etc. 

Synergists. — All those agents which promote constructive meta- 
morphosis are synergistic to arsenic. 

Physiological Actions. — Applied to the tissues, arsenic excites 
violent inflammation and causes destruction of the part ; it is, there- 
fore, an escharotic. Great pain attends its action. In consequence of 
the high degree of inflammation which it excites, when applied in suf- 
ficient strength, absorption does not follow its local use, but weak ap- 
plications may excite dangerous symptoms by diffusion into the blood. 



ARSENIC. 137 

Symptoms of poisoning follow the inhalation of arsenical fumes. 
Numerous instances have occurred in which wall-papers colored with 
arsenical pigments have poisoned the occupants of an apartment. Gar- 
ments colored with aniline dyes, fixed by arsenical mordants, have 
induced local ulcerations and systemic symptoms from absorption of 
arsenic. Applications to a large portion of even the unbroken integu- 
ment, and to ulcerated surfaces, have, in numerous instances, excited 
dangerous symptoms, and have produced fatal results. That arsenic, 
wherever applied, manifests a selective action on the mucous membrane 
of the respiratory and digestive tracts, is a curious fact. 

Arsenic, in small medicinal doses, promotes the appetite and diges- 
tive functions, and improves the body nutrition. It increases secretion 
of the gastro-intestinal mucous membrane, and hastens the peristaltic 
movements. Arsenic diffuses into the blood with facility. It probably 
enters into combination with the red-blood globules. It certainly 
lessens the excretion of carbonic acid, probably also of urea ; in other 
words, it checks the retrograde metamorphosis. It stimulates the 
cerebral functions and induces a feeling of well-being, and in some sub- 
jects decided mental exhilaration. 

In larger doses, yet not in quantity to produce acute poisoning, and 
when full medicinal doses have been administered for a lengthened 
period, arsenic causes more characteristic physiological actions than are 
described above. As regards the digestive organs, the following phe- 
nomena occur : A metallic taste ; increased flow of saliva ; nausea, 
vomiting of glairy mucus, epigastric pain, and soreness ; diarrhoea, 
tenesmus, and sometimes dysenteric stools. As regards the circulatory 
and respiratory organs : the action of the heart becomes irritable and 
feeble, palpitations, cough, oppressed breathing, cedema of the eyelids, 
general cedema, and albuminuria occur. As regards the skin : itching 
of the eyelids, urticaria, eczema, pityriasis, psoriasis, and falling out of 
the nails and hair. As regards the nervous system : disorders of motil- 
ity — trembling, stiffness, and contraction of the joints, disorders of 
sensibility, herpes zoster. 

Notwithstanding the effects above described are so frequently ob- 
served to follow the use of arsenic, it is undoubtedly true that a certain 
degree of tolerance may be established when doses in themselves toxic 
can be taken with impunity. This state has been produced in the 
course of the legitimate administration of arsenic, and has been wit- 
nessed on a considerable scale among the arsenic-eaters of Styria and 
Southern Austria. The arsenicophagi begin the habit of arsenic-eating 
at an early age, and become habituated to the use of enormous doses. 
They find that this practice is serviceable in several respects : they im- 
prove in bodil}' condition, gain in breathing-power, and become stronger 
and more pugnacious, and also more salacious. 

When arsenic is swallowed in sufficient quantity to cause the symp- 



138 RESTORATIVE AGENTS. 

toms of acute poisoning, the phenomena produced are of two kinds — 
gasforo-intestinal irritation and cerebral effects. The former is much the 
more common. The following are the symptoms of the gastro-intestinal 
form of acute arsenical poisoning: Burning at the epigastrium, and 
radiating thence over the abdomen ; violent and uncontrollable vomit- 
ing; great dryness of the mouth and fauces; intense thirst; intestinal 
irritation, bloody and offensive stools, retracted abdomen ; strangury, 
priapism, suppression of urire or bloody urine, and in females menor- 
rhagia; rapid and feeble action of the heart, oppressed breathing; 
great agitation and restlessness ; shrunken features, cold breath ; invol- 
untary evacuations ; collapse — consciousness being retained to the last. 
In the cerebral form of acute poisoning, without any symptoms of 
gastro-intestinal irritation, the patient is suddenly put into a condition 
of profound insensibility and coma, not unlike extreme opium narcosis. 

Recovery from the effects of acute arsenical poisoning is rarely com- 
plete. For a long time afterward a considerable degree of gastro-enteric 
irritability will persist, and life may at last be lost from the continued 
operation of this pathological state on the function of nutrition. An 
irritable state of the skin and stiffness of the joints may also continue 
for some time, and paralysis may supervene, accompanied with neuralgic 
pains, numbness, formication,' etc. 

The changes found after death in the gastro-intestinal mucous mem- 
brane are those due to an irritant : deep redness, erosions, ecchymoses, 
and softening. These alterations are also produced when toxic effects 
are caused by the external application of arsenic. More or less redness 
of the tracheal and bronchial mucous membrane and congestion of the 
lungs have been observed. It must not be forgotten that arsenic has 
caused a fatal result without producing any gastro-intestinal lesions ex- 
cept some uncharacteristic redness. Fatty degeneration of the liver, 
kidneys, spleen, and other organs, has been observed in cases of acute 
poisoning, even when the symptoms have existed for a few hours. The 
icterode hue of the skin and the albuminuria which occur in the course 
of chronic arsenical poisoning are probably due to fatty degeneration 
of the liver-cells and of the renal epithelium. 

Arsenic, although like other mineral poisons it tends to accumulate 
in the system, is nevertheless eliminated with considerable rapidity. 
If the patient survive a week after the ingestion of a toxic dose, it is 
difficult to detect it in the body after death. If the poison is retained, 
and death ensues before elimination can take place, it undoubtedby re- 
tards putrefaction. Arsenic is eliminated by various organs — by the 
liver, intestinal canal, kidneys, and bronchial tubes — and some of the 
symptoms produced by it probably have their origin in the local effect 
of the poison on the channels of excretion. 

The quantity of arsenic required to produce a fatal effect varies 
according to the state of the stomach and the susceptibilities of the 



ARSENIC. 139 

patient. Ounces have been swallowed without producing even serious 
symptoms, because promptly rejected by vomiting. When the stomach 
is full of food, absorption is slow and vomiting is easily induced, and 
hence a toxic dose may not under these circumstances produce any 
of the phenomena of poisoning. A half-grain of arsenious acid has 
caused symptoms of poisoning (Taylor), and, according to the same 
authority, from two to four grains may prove fatal to an adult. Much 
depends on the idiosyncrasies of the individual, which, as has been 
stated above, differ greatly in different persons. These facts should 
not be forgotten in prescribing strictly medicinal doses of arsenical 
preparations. 

From this general survey of the effects of arsenic, we may properly 
proceed to study the results of more minute investigations. Virchow 
has pointed out the similarity in the post-mortem appearances of 
arsenic and of cholera. The cholera-fungus of Klebs and the charac- 
teristic rice-water contents of the intestinal canal were not wanting to 
complete the resemblance. Hoffman has since fully confirmed these 
observations. Croupous exudations are sometimes encountered in the 
stomach and intestines, and crystals of arsenic have been found im- 
bedded in the false membrane. This result is due to the action of 
arsenic when swallowed in powder, and is not produced when the 
poison is taken in solution (Filehne, Lesser). The gastro-intestinal in- 
flammation, present in a large proportion of cases, is due in part to the 
local action of the arsenic, in part to its selective action, but this, fact 
does not justify the statements of Bohm and Unterberger that a larger 
dose of the poison is required to destroy life by the intravenous injec- 
tion than by the stomachal administration. Lesser holds with the 
authorities in general that arsenic, in common with other poisons, is 
more fatal by intravenous injection. In a small proportion of cases, 
as has been stated, gastro-intestinal inflammation does not occur, but 
the effects of the poison are expended on the nervous centres ; several 
hours after the ingestion of a large dose, delirium, followed by coma, 
and convulsions come on, and with these albuminuria, occasionally 
urinary suppression. The relation of the attacks of eclampsia to the 
albuminuria has not been settled. In still other cases the gastro-intes- 
tinal disturbance, the rice-water discharges, the collapse, simulate the 
algid stage of cholera. The remarkable fall in the blood-pressure of 
the abdominal vessels produced by arsenic certainly throws light on 
these phenomena (Bohm and Unterberger). 

The experiments of Sklarek have demonstrated that arsenic de- 
cidedly impairs sensibility, leaving the motor functions untouched. In 
the human subject, however, as the result of acute poisoning, and 
sometimes after the acute symptoms have subsided, certain paralyses 
develop. They may be preceded by numbness and tingling, and may 
be accompanied by contractures which disappear in curable cases, and 



140 RESTORATIVE AGENTS. 

remain permanently in incurable cases. The paralysis may be limited 
to a single member, and when several are thus affected the usual form 
of paralysis is paraplegia ; but all four members may be thus disabled. 
The rectum and bladder are not affected (Christison). These clinical 
observations by Christison are confirmed by the researches of Ringer 
and Murrell, who have shown that Sklarek's statements were incor- 
rect, and that motor paralysis precedes sensory paralysis in the frog 
poisoned by arsenic. (See Ponteland Poisoning Cases, Lancet, Sep- 
tember, 1866.) 

The effects of arsenic on the circulation are not the same in cold 
and warm blooded animals, for, according to Sklarek, in the former 
the action of the heart is slowed, then arrested, while in the latter the 
action of the heart persists after the cessation of respiration (Bohm 
and Unterberger, Lesser). This fundamental difference in the action 
of arsenic on the two classes of animals requires us to accept with 
caution the observations made on the vaso-motor system of the cold- 
blooded. It has been pretty definitely ascertained that arsenic causes 
a fall in the blood-pressure, which is especially strong in the abdomi- 
nal blood-vessels (Bohm and Unterberger). 

A fact of great importance, first ascertained by Saikowsky, is the 
fatty degeneration of the liver, kidneys, heart, and other organs. The 
case of Grohl and Mosler reported in the same volume of Virchoid's 
Archiv, containing Saikowsky's paper, is confirmatory more or less 
completely of the observations in the latter. They found, as their 
figures well exhibit, fatty degeneration to a greater or less extent in 
the glandular epithelium of the intestinal canal, and less conspicuous 
evidences of the same change in the kidneys, the liver, and the muscu- 
lar tissue of the heart. As the extent of the change is determined 
largely by the duration of the case, when death occurs in a few hours, 
or in a day or two, little alteration is discernible. 

The effect of arsenic on the function of nutrition is as yet involved 
in doubt. It is a recognized fact that arsenic promotes constructive 
metamorphosis when administered in medicinal doses. It has been 
ascertained by Saikowsky that it arrests the formation, of glycogen by 
the liver, and C. Schmidt has shown that it lessens the excretion of car- 
bonic acid and urea. Although doubt has been thrown on these state- 
ments, they seem to be supported by the observations of Lesser on the 
temperature which has been constantly and considerably depressed 
under the action of lethal doses. The effect of arsenic in lowering 
the functional activity of the respiratory centre is a fact which sup- 
ports the same view, for a diminution in the quantity of oxygen 
admitted to the blood must necessarily lessen the rate of oxidation. 
On the other hand are the adverse experiments of Kassel, a medical 
student under Prof. Gathgens, and Gathgens himself, which appar- 
ently demonstrate an actual increase in the amount of urea excreted. 



ARSENIC. 141 

Arsenic has an anti-fermentative action ; but it is not universally 
destructive of the minute organisms on the presence of which the 
various fermentations are dependent. Thus it is poisonous to Torala 
cerevisicu and to some micrococci, but not to all, and it does not inqjair 
the activity of certain animal ferments, as pepsin, pancreatine, etc. 
(Johannsohn, Schafer, and Bohm). On the trophic system it acts as a 
depressant when taken in considerable quantity. The dust from 
arsenical wall-papers has induced a cachectic state, accompanied by 
headache, vertigo, and tinnitus (Donkin). Aniline dyes fixed by a 
mordant of arsenic have excited ulceration of the nails, phlegmon of 
the hands, and anaesthesia and paresis of the extremities (Clemans). 

Therapy. — The preparations of arsenic are applicable to the treat- 
ment of the diseases of those tissues upon which it has a selective 
action. 

No remedy is more useful than arsenic in the so-called irritative 
dyspepsia, manifested by these symptoms : a red and pointed tongue, 
poor appetite, distress after meals, the presence of the food causing 
intestinal pain, colic, and the desire to go to stool. Drop-doses of 
Fowler's solution, given before meals, quickly relieve this state of 
things. The effects of the arsenic are frequently favored by the con- 
joint administration of a little laudanum. 

In some cases of the vomiting of pregnancy, a drop of Fowler's 
solution given before each meal will afford astonishing relief. The 
particular indications for its use are these : vomiting of food, followed 
by retching and straining, the vomited matters being streaked with 
blood, or blood alone being thrown up ; these symptoms accompanied 
by gastralgia and pain between the scapula?. 

The vomiting of chronic gastric catarrh, especially the alcoholic 
form, is relieved by one or two drops of Fowler's solution taken before 
meals. It effects a cure in these cases by relieving the morbid state of 
the mucous membrane on which the vomiting depends. Arsenic is 
also very beneficial in these small doses in chronic ulcer of the stomach. 
It checks the vomiting, relieves the pain, and improves the appetite for 
food. It is not equally effective in the acute ulcer. Although arsenic 
exercises but little influence over the progress of these cases, it is very 
serviceable in cancer of the stomach, by diminishing the pain and 
checking the vomiting. Gastralgia and enteralgiq, when idiopathic, 
are sometimes made to disappear in a very surprising manner by the 
same remedy, but there are no certain indications of the kind of case to 
which it is best adapted. 

In the treatment of stomach-disorders, only small doses of arsenic 
are admissible. Large doses, by creating an irritation of the gastric 
mucous membrane, will only defeat the end in view. 

That form of diarrhoea which consists merely in an intolerance of 
the presence of food, an evacuation of the undigested aliment taking 



142 RESTORATIVE AGENTS. 

place soon after it is swallowed, is cured by arsenic. Chronic diarrhoea 
and dysentery (entero-colitis), especially when dependent on the changes 
induced by chronic malarial infection, are often greatly benefited by the 
same remedy. In these cases, two drops of Fowler's solution with five 
drops of laudanum should be given before meals. Attention to the diet 
is, of course, imperative. Constipation, when due to deficient secretion 
and dryness of the faeces, is sometimes overcome by small doses of Fow- 
ler's solution. 

Arsenic is one of the numerous remedies proposed for the treatment 
of epidemic cholera. It is a curious circumstance, first demonstrated by 
Virchow, that some cases of acute arsenical poisoning are not distin- 
guishable by their symptomatology or morbid anatomy from cases of 
epidemic cholera. 

Arsenic has been used with success in the treatment of the jaundice 
due to catarrh of the bile-ducts succeeding to catarrh of the duodenum. 
It seems to the author to be better adapted to cases of jaundice of mala- 
rial origin. Excellent results are obtained by the persevering use in 
small doses of arsenic in cirrhosis. As arsenic tends to accumulate in 
the liver, and as it produces fatty degeneration of this organ, the cura- 
tive effect in the above-named disorders may depend on this selective 
action. 

There is no doubt that arsenic promotes in a very decided manner 
the constructive metamorphosis. It is one of the most valuable, agents 
which we possess in the treatment of chlorosis and ancemia. It is espe- 
cially adapted to those cases in which iron does not agree or fails of 
effect. The efficiency of iron in these disorders is much increased by 
combination with arsenic. 

Cases of acute coryza and hay-asthma are often decidedly relieved 
by this remedy. Chronic catarrh of the broncho-pulmonary mucous 
membrane, emphysema, sclerosis of the lungs, are maladies in which 
arsenic, long used in ordinary medicinal doses, is capable of effecting 
considerable amelioration. We have no single drug of equal utility in 
the chronic forms of phthisis, but it is not serviceable in caseous pneu- 
monia. It is said, and this statement corresponds to the author's obser- 
vation, that, when there are much hectic and rapid disintegration of the 
pulmonary tissues, arsenic is not beneficial. Besides the stomach ad- 
ministration of arsenic in the above-mentioned maladies of the respira- 
tory organs, it is used with advantage by the process of fumigation. 
The following is the formula of Trousseau for arsenical cigarettes : 

Arsenite of potassa 15 grains. 

Distilled water 1 ounce. 

Unsized white paper is thoroughly moistened with this solution, 
dried and cut into twenty equal parts, and each part rolled into a cigar- 
ette. Two or three of these are smoked daily for the relief of chronic 



ARSENIC. 143 

bronchitis, emphysema, spasmodic asthma, phthisis, hay-asthma, etc. 
The arseniate of soda may be used in the same "way, and under the 
same conditions ; for example, take a half-drachm to one drachm of ar- 
seniate of soda, one ounce of distilled water, and moisten a bit of unsized 
paper with the solution, so that every piece of a given size shall contain 
a determined quantity of the arsenic, ordinarily from one-fourth to one 
grain. When the cigarette is lighted, the patient inhales the smoke by 
a single inspiration, and this inhalation is practised three or four times 
a day. In cases of acute and chronic coryza, great advantage is ob- 
tained by snuffing into the nares the fumes of arsenical cigarettes. The 
arsenite of antimony, according to Dr. Lucien Papillaud, is especially 
serviceable in pulmonary affections. 

When, in consequence of feebleness of the heart, there are present 
short breathing on making slight exertion, and oedema of the feet and 
ankles, especially as these symptoms occur in old people, arsenic is indi- 
cated. Attacks of angina pectoris may be lessened or prevented by the 
persistent use of arsenic in the interval. 

Certain disorders of the nervous system are greatly benefited by the 
use of arsenical preparations. The author has seen it extremely useful 
in cerebral congestion, for the treatment of which it was originally 
recommended by Dr. Lemare-Picquot. It is indicated when there are 
commencing setheroma of the cerebral vessels, sluggish venous circula- 
tion, puffiness of the eyes, tendency to drowsiness, and intellectual tor- 
por. In the melancholy and hypochondria of the aged, it gives great 
comfort, and frequently entirely dispels the gloonry fancies which take 
possession of the mind under these circumstances. The arsenic acts 
most favorably when combined with minute doses of opium ; viz., two 
drops of Fowler's solution, with three to five drops of tincture of opium, 
given three times a day. Arsenic is one of the remedies successful in 
the treatment of neuralgia. Generally its curative influence is indirect, 
and exerted through the improvement in the bodily nutrition, which fol- 
lows its administration. It is directly curative, however, in the cases 
of hemicrania and other neuralgias of malarial origin, but it holds a 
place strictly secondary to quinia in these affections. It is certainly one 
of the most effective remedies which we possess in the treatment of 
chorea. In this disease, large doses — five minims ter in die — must be 
given. Young subjects, it should be remembered, bear large doses of 
arsenic, relatively, better than adults. Cases of epilepsy have been 
reported cured by arsenic, but these were probably instances of epilepti- 
form vertigo caused by stomach-disorder, in which this remedy is un- 
doubtedly of great utility. Charcot has found the subcutaneous injec- 
tion of Fowler's solution of real value in paralysis agitans. The same 
expedient has succeeded in local chorea and histrionic sjyasm. The in- 
jection should be made into the affected muscles, whenever practicable. 

Arsenic produces, in the course of its medicinal administration, affec- 



144 RESTORATIVE AGENTS. 

tious of the skin, and notably those dependent on an unknown state of 
the trophic nerves. In the treatment of various skin-affections we avail 
ourselves of this physiological fact, and set up by means of arsenical 
preparations a substitutive action in the skin. It follows, that arsenic 
will not be serviceable in acute affections of the skin, and experience 
demonstrates that, whenever active cell-proliferation is taking place, 
arsenic is contraindicated. It is most serviceable when the affection of 
the skin is superficial in its seat — in the epidermis and the superficial 
layers of the derma. In cases of psoriasis much good may be ex- 
pected from it, but, the more chronic the disease, the more beneficial 
is it. When the arsenic begins to exert an influence on psoriasis, the 
skin appears more inflamed, but this is an evidence that the cura- 
tive action is taking place, and the remedy should then be persisted 
in. Acute eczema is rather exasperated by arsenic, but chronic eczema, 
especially eczema squamosum, is often greatly benefited by it. When 
eczema infests the vulva, anal region, and scrotum, arsenic is said to be 
useful, but its efficacy in these cases is largely determined by the chro- 
nicity of the attacks. Pemphigus is an affection of the skin, which, as 
was more particularly shown by Mr. Hutchison, is curable by arsenic, 
but the more chronic the disease the more certainly beneficial the rem- 
edy. In old cases of acne, especially acne rosacea, arsenic is sometimes 
serviceable, but it is often very disappointing. The author has not ob- 
served much good to follow the use of arsenic in the acne which occurs 
at puberty and for some years subsequently. In all cases of acne the 
strictest attention to diet and a proper hygiene is very important. Ar- 
senic given with bromide of potassium lessens or prevents the very dis- 
figuring acne which appears in the course of the administration of that 
agent. Furuncle (boils) is successfully treated, by the long-continued 
use of arsenic. This practice is strongly urged by Dr. Delioux de 
Savignac. A succession of boils is the indication for the use of this 
remedy. 

In the treatment of skin-affections, Fowler's solution is the arsenical 
preparation most frequently employed. The commencing dose need not 
be larger than five drops three times a day, given after meals. It is bet- 
ter to commence with the maximum dose, and to diminish the amount 
gradually. As arsenic needs to be administered for a long time in skin- 
diseases, such toxic symptoms as irritation of the eyelids, and puffiness 
of the eyes, and epigastric pain and soreness, are apt to arise. These 
symptoms are indications for the use of laxatives, and for a reduction 
in the dose of the remedy, but not for its entire suspension. In order to 
prevent relapses, the use of arsenic should be continued, in diminishing 
doses, for some time after the entire disappearance of the eruption. 

Arsenic is not serviceable in skin-diseases of syjihilitic origin. In 
very chronic cases of this kind the compound solution of arsenic, iodine, 
and mercury — Donovan's solution — is sometimes very effective, but the 



ARSENIC. 145 

curative effect is here due to the iodine and mercury, rather than to the 
arsenic. 

Arsenic is very useful in a certain form of chronic arthritis. The 
cases to which it is adapted are those in which the joints become tumid 
and stiff ai.d painful in consequence of a peculiar state of the nervous 
sj-stem ; indeed, the condition is one allied to neuralgia, the trophic 
nerves being involved. This is a malady very different from that kind 
of chronic rheumatism or rheumatic gout which is accompanied by no- 
dosities of the joints, in which arsenic has been recommended, but over 
which, according to the experience of the author, it exerts no control. 

Arsenic has seemed to the author remarkably beneficial in diabetes 
of hepatic origin. It has also been found useful by Johannsohn. 
Brunton reports good results from its administration in albuminuria, 
apparently due to defective digestion of albumen. 

Amenorrhcea, when due to functional inactivity of the ovaries, and 
menorrhagia, when produced by anaemia, are equally benefited by the 
preparations of arsenic, especially when combined with iron. Sperma- 
torrhoea, if dependent on a weak and relaxed state of the seminal vesi- 
cles, and functional impotence, are sometimes greatly improved by full 
doses of the arseniate of iron. It is often advantageous to combine the 
arseniate of iron and ergotine, as follows : 1J • Ferri arseniat., gr. v ; ergo- 
tine (aq. ex.), 3 ss. M. ft. pil. no. xxx. Sig. One night and morning. 

Next to quinia, arsenic has the most important position in the treat- 
ment of malarial fevers. It may be used to prevent the recurrence of 
attacks of ague when quinine for any reason is not admissible. As 
regards acute malarial toxaemia, arsenic is more useful as an adjunct to 
quinia than as the sole remedy. The treatment of acute cases ma} 7 be 
formulated as follows : large doses of quinia to interrupt the paroxysms, 
and at the septenary periods ; arsenic given daily to prevent relapses. 
It plays a more important role in chronic malarial diseases. As has 
been shown by Boudin, arsenic diminishes the engorgement of the 
spleen. The author has witnessed the rapid disappearance of malarial 
jaundice, and the cure of the alterations in the glandular appendages 
of the intestinal mucous membrane, under its use. It is most useful 
generally to combine iron with arsenic in the chronic form of malarial 
disease. $. Pil. ferri carbon., 3 j; acidi arseniosi, gr. j. M. ft. pil. no. 
xx. Sig. One three times a day. Tfr. Quinise sulph., 3ij; ferri sulph. 
exsic, 3 j ; acidi arseniosi, gr. j. M. ft. pil. no. xx. Sig. One three 
times a day. Boudin justly insists upon abundant alimentation during 
a course of arsenical treatment of intermittents, and, with a view of pre- 
paring the digestive organs, administers a preliminary emetic to relieve 
the stomach of the embarras gastrique. Arsenic has also been used as 
a prophylactic against malarial infection, and as a remedy for various 
intermittent diseases due to malarial influence. The author has seen 
excellent results from the use of small doses of Fowler's solution three 
11 



146 RESTORATIVE AGENTS. 

times a day in typho-malarial fever. When there is much diarrhoea, a 
few drops of tincture of opium should be added to each dose of arsenic. 
In doses of half a drop to one drop of Fowler's solution, the tongue 
oleans, the skin becomes moist, and the delirium lessens in a most re- 
markable manner, sometimes. When arsenic is used alone in the treat- 
ment of intermittents, large doses are necessary. Ten drops of Fowler's 
solution may be given after meals to adults, but in a few days — three, 
four, or five, according to the susceptibility of the patient — the dose 
must be reduced two drops each day until four drops are reached. If 
the stomach does not become disordered, slight irritation of the conjunc- 
tivae and puffiness of the eyelids may be disregarded. 

There can be no doubt that the long-continued use of small doses of 
arsenic exercises a favorable influence over the course and progress of 
epithelioma. It has appeared, indeed, to be useful in scirrhus, espe- 
cially as this morbid process manifests itself in the stomach. Rodent 
ulcer, which is closely allied in its nature to epithelioma, is also im- 
proved by it. With the internal use of the arsenical preparations may 
be conjoined the local applications of arsenious acid. ' Many physicians, 
notably Dr. Atlee, of Philadelphia, entertain the belief that the long- 
continued use of arsenic retards the growth of uterine cancer. It ap- 
pears to the author to be certain that arsenic is useful in epithelioma, 
but he regards it as improbable that it exerts a curative influence over 
the other forms of cancer, although it alleviates some of the distress ex- 
perienced by the subjects of cancer of the stomach. Billroth reports a 
case of multiple lymphoma cured by the use of arsenic. 

External Uses of Arsenic. — An arsenical paste having the following 
composition is used to destroy the sensibility of a carious tooth : arse- 
nious acid, ij ; sulphate of morphia, j ; sufficient creosote to make a 
paste. A small quantity of this is applied by a bit of cotton-wool to the 
carious portion of the tooth. 

Arsenious acid is sometimes employed to destroy cancerous growths. 
But, as it is extremely painful, and as the danger of absorption is great, 
other escharotics, as, for example, the chloride of zinc, are generally 
preferred. When it is used, the operator should be careful to employ an 
arsenical paste of sufficient strength to set up a limiting inflammation, 
and thus prevent absorption. From one-sixth to one-fifth of arsenious 
acid is the proper proportion, and it may be mixed with calomel, starch, 
or other impalpable powder. If the surface to be destroyed is large, a 
portion of it should be submitted at a time to the action of the escha- 
rotic. Poultices should then be applied until the slough separates, when 
a healthy granulating surface is obtained. The excessive pain caused by 
the escharotic may be much alleviated by combining morphia and car- 
bolic acid in the arsenical paste, or by the use of morphia hypodermi- 
cally until the escharotic action ceases. 

An arsenical paste prepared as follows is sometimes used as a de- 



ARSENIC. 147 

pilatory : quicklime, 3 ss ; yellow sulphide of arsenic, grs. xx ; starch, 
3 ij. Sulphide of barium and oxide of zinc is a more efficient com- 
bination. Esmarch's caustic is composed of : Arsenious acid, one part; 
morphia sulph., one part ; calomel, eight parts ; and pulv. acacia? 
forty-eight parts. Mix. Sprinkle thickly every day on a surface 
either raw or denuded of cuticle by a blister. 

In addition to the above local uses of arsenic, the results achieved 
by its hypodermatic injection should be mentioned. Dr. Radcliffe was 
the first to employ this practice in cases of local chorea of the head 
and neck, and in histrionic spasm. In these affections Fowler's solu- 
tion or Pearson's, in doses of two to ten minims diluted with an equal 
measure of water, is thrown into the affected muscles daily, sometimes 
curing after some weeks of treatment. In obstinate cases of general 
chorea the subcutaneous injection of arsenic is now practised, with 
good effects, a cure resulting more speedily than by the stomachal 
method of administration. 

Authorities referred to : 

Gathgens, C. Zur Kenntniss dcr Arsenwirkungen, Centralblatt f. d. med. Wiss., 32, 
1875, p. 529. 

Gies, Dr. Thos. Experimentelle Uhtersuchungcn iiber den cinftuss des Arsens auf 
den Organismus. Archiv fur experimentelle Path, und Pharm., vol. viii., p. 176. 

Grohe, Fr., und Mosler, Fr., Profs. Zur Kenntniss der Veranderungen innerer Or- 
ganc bci acuter Arsenvergiflung. Virchow's Archiv, Band xxxiv., p. 20S. 

Hebra, Prof. Dr. On Diseases of the. Skin. Syd. Society edition, 1868. 

Hermann, Prof. Dr. Lehrbuch dcr cxperimenteUen Toxicologic, Berlin, 1874, p. 224. 
Arsenvcrbindungcn. 

Hoffman, Prof. Dr. Arscnikvcrgiftung und Cholera. Virclww's Archiv, vol. 1., 
p. 455. 

Hunt, Thomas, Mr. On the Treatment of Chronic Diseases of the Skin. The Lancet, 
vol. i., 1846. 

Isnard, M. Bulletin General de Therapcutique, vol. lxxxiv., p. 80. Ibid., vol. lxxii. 

Johannsohn, Nicolai. Ueber die Einwurkung der arsenigen Saurc auf Gahrungsvor- 
gange. Archiv fur experiment. Pathol, und Pharmacol., vol. ii., p. 99. 

Kossel, Albrecht. Zur Kenntniss der Arsenwirkungen in Prof. Gathgens Labor, zu 
Rostock. Archiv f. exper. Pathol, u. Pharm., vol. v., p. 128. 

Lesser, A. Archiv fur path. Andtomie und Physiologie, 1S73, p. 398, and 1874, p. 
603. 

Lolliot, M. Bulletin General de Therapcutique, vol. lxxv., p. 338. 

Marme, W. Vergleichende Versuche iiber die Wirkungen der arsenigen Saure, und 
der Arsensaure. Abstract in Virchow und Hirsch., vol. i., 1876. 

Marsden, Dr. Alexander. A New and Successful Mode of treating Cancer, London, 
1869, p. 96. 

Ponteland Poisoning Cases. The Lancet, September 22, 1866, p. 337. 

Routh, Dr. C. H. F. Obstetrical Transactions, vol. viii., p. 290. 

Ringer and Murrell. Journal of Physiology, vol. i., p. 217. 

Scolosuboff, Dr. Sur la localisation de V arsenic dans les tissus d la suite de Vusage 
dcs Arscnicaux. Archiv der Physiol. Norm, et Path., vol. v., p. 563. 

Sklarek, Dr. W. Archiv fiir Anat. und Physiologie, 1866, p. 41. The Physiological 
Effects of Arsenious Acid. 



148 RESTOKATIVE AGENTS. 

Schafer, F., dnd Bohm. Ucbcr den Einfluss dcs Arscn auf die Wirkung ungeformles 
Fermcnle. Virchoio u. Hirsch., vol. i., 1872. 

Siiulz, Dr. H. Wcitercr Beitrag zur Tlieorie des Arsenwirkung. Archiv fur experi- 
ment. Pathologie u. Pharmacol, vol. xiii., p. 256. 

Unterberger, S. Miigetheilt von Prof. Bohm. Beitrage zur Kcnninus der phydolo- 
gischen WirJcungen der Arsenigen Satire. Ibid., vol. ii., p. 89. 

Virchow, R. His Archiv, vol. xlvii., p. 524. Choleraahnlichcr Befund bei Arsenik- 
vergiflung. 

Note.— Other references omitted for lack of space. 



THE SIMPLE BITTERS. 

Quassia. — Quassi amer, Fr. ; Quassienholz, Ger. The wood of 
Simaruba excelsa. 

Preparations. — Extraction Quassice. Extract of quassia. Dose, 
gr. j— gr. iij. 

Tinctura Quassice. — Tincture of quassia (2 oz. to Oj). Dose, m. 
v-3j. 

Infusum Quassias. — Infusion of quassia ( 3 ij to Oj). Dose, 3 ij 

Composition'. — Quassia-wood contains a crystallizable bitter prin- 
ciple, neutral, called quassin. 

' Gentiana. — Gentian, gentiane, Fr. ; Bitterwurzel, Ger. The root 
of Gentiana lutea. 

Preparations. — Infusum Gentiance Gompositum. Compound in- 
fusion of gentian. (Gentian, bitter orange-peel, coriander.) Dose, 

3 j— 1 j- 

Tinctura Gentiance Composita. — Compound tincture of gentian. 
(Gentian, bitter orange-peel, cardamom, alcohol.) Dose, 3 ss — 3 ij. 

Extractum Gentiance Fluidum. — Fluid extract of gentian. Dose, 
3 ss — 3 ij. 

Extractum Gentiance. — Extract of gentian. Dose, gr. j — gr. v. 

Composition. — Gentian contains a peculiar principle, gentianine, 
and an acid, gentisic acid. 

Gentiana Catesbaei. — Blue gentian, American gentian. This in- 
digenous remedy may be used as a substitute for the foreign gentian, 
and similar preparations to the officinal formula for gentian, as above, 
ma}' be prepared from it. 

Unofficial Eormulce. — Mistura gentianae alkalina. Dilute hydro- 
cyanic acid, m. iij ; bicarbonate of soda, grs. xv ; compound infusion of 
gentian to oz. j. 

Mistura Gentiance et Sennce. — Infusion of gentian, drachms vj ; 
infusion of senna, drachms iij ; compound tincture of cardamoms, 
drachm j. 

Calumba. — Colombe {racine de),Fv.; Ruhrwurzel, Ger. The root 
of Cocculus palmatus. 



THE SIMPLE BITTERS. 149 

Preparations. — Infusum Calumbce. Infusion of calumba ( § j — 
Oj). Dose, § es — § ij. 

Tinctura Calumbce. — Tincture of calumba ( §* ij — Oj). Dose, 3 ss — 

3 ij- 

Extraction Calumbcn Fluidum. — Fluid extract of calumba. Dose, 
3 ss — 3 ij. 

Composition. — A peculiar principle, colombin, berberina, and a 
peculiar acid, colombic acid. 

Goptis. — Goldthread. The root of Coptis trifolia. There are no 
official preparations of coptis. It contains, in common with some 
other bitters, the alkaloid, berberina, and probably also, a peculiar bitter 
principle. It yields up its alkaloids and bitter principle to both water 
and alcohol, but more freely to the latter. The tincture and fluid ex- 
tracts are, therefore, the best preparations. 

Sabbatia. — American centaury. Herb of Sabbatia angularis. As 
there are no official preparations of sabbatia, a tincture and fluid 
extract made in accordance with the general instructions given in the 
United States Pharmacopoeia may be used. 

Comus Florida. — Dogwood. The bark of Corn us Florida. 

Preparation. — Extractum Corn-as Florida?, Fluidum. Fluid ex- 
tract of dogwood. Dose, m. x — 3 j- 

Decoctum Comfls Floridoe. — Decoction of dogwood ( § j — Oj). 
Dose, 3 ss — : | ij. 

Antagonists and Incompatibles. — Quassia and calumba can be 
administered with the salts of iron. The sulphate of iron, and the sil- 
ver and lead salts, are incompatible with gentian. The infusion of 
coptis is not affected by the salts of iron, but is precipitated by the 
nitrate of silver and acetate of lead. Therapeutically, all those agents 
which promote waste or destructive metamorphosis are opposed to the 
action of the simple bitters. 

Synergists. — Iron, the mineral acids, pepsin, bismuth, etc., are syn- 
ergistic to the bitters, and under some circumstances the alkalies pro- 
mote their therapeutic action. 

Physiological Actions. — The simple bitters increase secretion 
from the mucous membrane. In the mouth they promote the flow of 
saliva, and in the stomach they appear to increase the production ot 
gastric juice, and also of gastric mucus. It follows that an increase of 
digestive capacity is one result of their administration. The increased 
appetite which is observed from the use of the bitters is probably due 
to two factors : the sense of bitterness which increases the desire for 
food, and the improved digestive power which, enabling more food to 
be disposed of, postpones the sense of satiety. Furthermore, the bit- 
ters, by removing morbid states of the intestinal mucous membrane, 
favor assimilation. More food being taken and more thoroughly di- 
gested it is obvious that the bitters promote constructive metamor- 



150 RESTORATIVE AGENTS. 

phosis. The blood is indirectly enriched by them, and the tissues are 
consequently improved in their nutrition. The simple bitters are ac- 
cordingly usually classed with tonics. 

Although these remedies, used judiciously and for a short period, 
undoubtedly promote the constructive metamorphosis, yet their long- 
continued use will produce gastric catarrh, decrease the flow of healthy 
gastric juice, and impair digestion. 

Therapy. — An infusion of coptis has much reputation in New Eng- 
land as a remedy in aphthce, psoriasis of the mucous membrane, ulcers, 
and epithelioma. Used as a gargle, it is serviceable in ulceration of 
the tonsils. 

A few drops of the tincture of calumba, or a teaspoonful of the in- 
fusion, will sometimes greatly relieve the vomiting of pregnancy, and 
is also occasionally efficacious in seasickness. The simple bitters are 
especially indicated in atonic dyspepsia, and in chronic gastric catarrh. 
They are useful in this state of things : pain after food, slow digestion, 
constipation alternating with diarrhoea. Calumba is the mildest, and 
may be borne when quassia and gentian disagree. According to Wil- 
son Fox, " calumba holds the chief place in point of therapeutic value 
as a remedy which can be safely employed when others of the class 
would be too irritating." When there are much relaxation and torpor, 
quassia is very useful as a stomachic tonic. Sometimes an extempo- 
raneous cold infusion of quassia is used, made by filling overnight with 
cold water a quassia-cup — a goblet turned out of quassia-wood. When 
constipation exists in cases of atonic dyspepsia, good results are ob- 
tained by a combination of gentian with senna, as in the formula already 
given. The compound tincture of gentian is an excellent vehicle for 
the administration of cod-liver oil, and contributes to its digestion and 
assimilation. 

The infusions of gentian, calumba, and quassia, are usefully em- 
ployed as vehicles for the administration of acids and alkalies in cases 
of acidity and deficient supply of gastric juice, under the rules given in 
the articles on acids and alkalies. 

In convalescence from acute diseases, the simple bitters, especially 
gentian and calumba, are employed to promote the appetite and diges- 
tion, and thus to aid in the process of constructive metamorphosis. 

In the diarrhoea which is due to relaxation of the mucous membrane, 
and is not dependent on inflammation, the tincture of calumba is often 
useful. The author has obtained good results from the use of tincture 
of calumba combined with opium in the treatment of an irritable state 
of the intestinal mucous membrane, indicated by these symptoms : Soon 
after taking food, the occurrence of pain referable to the small intes- 
tines, nausea, loose evacuations containing undigested aliments, and 
followed by weakness and depression. rj. Tinct. calumbae, 3xv; 
tinct. opii deodor., 3j. M. Sig. A teaspoonful in a wineglassful of 



AROMATIC BITTERS. 151 

water before meals. Calumba is also serviceable in the relaxation of 
the bowels, succeeding tc acute affections of the intestinal mucoug 
membrane. 

The infusion of quassia is one of the most effective injections for 
the destruction of the ascarides vermiculares which infest the rectum. 
The stomach administration of simple bitters undoubtedly hinders the 
development of intestinal worms, probably by correcting a morbid state 
of the mucous membrane. In the treatment of intestinal parasites much 
good, therefore, is derived from the use of bitters, administered with 
the view of restoring normal digestion. 

According to Wood, the remedy most effective to remove and " per- 
manently cure a disposition to the accumulation of flatus in the bowels 
is an infusion made with half an ounce of calumba, half an ounce of 
ginger, a drachm of senna, and a pint of boiling water, and given in the 
dose of a wineglassful three times a day." 

The bitters are used as remedies in malarial fever. Although they 
exercise but little influence over the course of intermittent and remit- 
tent fever, they are useful in the form of infusion as vehicles for the 
administration of more active drugs. In the convalescence from mala- 
rial fever, and in chronic malarial poisoning, they are more actively 
beneficial as agents promoting constructive metamorphosis. The dog- 
wood, of all the bitters given in the above list, possesses the most 
positive antiperiodic qualities, and is considered by the physicians of 
Southern United States as next to quinia in efficiency. An excellent 
tonic combination of decided utility in chronic malarial disease is the 
following: Dogwood-bark, calumba, poplar (liriodendron), wild-cherry, 
of each six ounces ; boneset (eupatorium) and cayenne pepper, of each 
four ounces. Mixed and sifted. Of the mixture a teaspoonful in cold 
or warm water, three or four times a day. A useful tincture to serve 
the purpose of a tonic, and as a remedy in malarial affections, may be 
prepared from the above combination of bitter tonics. 

AROMATIC BITTERS. ' 

Serpeiltaria. — Virginia snaheroot. Serpentaire de Virginie, Fr. 
Schlangenwurzel, Ger. The root of Aristolochia serpentaria, and of 
other species of Aristolochia. 

Preparations. — Infusum Serpentarim. — Infusion of serpentaria 
(Iss— Oj). Dose, §ss— lj. 

Tinctura Serpentaria?. — -Tincture of serpentaria ( 3 iv— Oij). Dose, 
3 ss— 3 ij. 

Extractum Serpentaria} Fluidum. — Fluid extract of serpentaria. 
Dose, 3ss — 3 ij. 

Composition. — A volatile oil,- resin, a bitter principle, etc. 

Primus Virginiana. — Wild cherry. The bark of Cerasus serotina. 



152 RESTORATIVE AGENTS. 

Peepaeations. — Infusum Pruni Virginiance. — Infusion of wild- 
cherry ( 3 ss — Oj). Dose, 3 ss — 3 ij. 

Extractum Pruni .Virginiance Fluidum. — Fluid extract of wild- 
cherry bark. Dose, 3 ss — 3 j. 

Syrupu-s JPruni Virginiance. — Sirup of wild-cherry. Dose, 3j — 

3ij. 

Composition. — Amygdalin and emulsin, which produce by their 
reaction hydrocyanic acid, tannic and gallic acids, etc. 

Cascarilla. — Cascarilla. Cascarille, Fr. ; Cascarille Hinde, Ger. 
The bark of Croton eleuteria. 

Peepaeations. — Infusum Cascarillce. Infusion of cascarilla ( § j — 
Oj). Dose, i ss — § j. 

Composition. — A crystallizable principle, cascarillin, tannic acid, a 
volatile oil, etc. 

Actions and Uses. — These remedies possess the quality called tonic ; 
they invigorate digestion, and promote constructive metamorphosis. 
They differ from the simple bitters in containing aromatic constituents, 
and in being astringent to a greater or less degree, owing to the pres- 
ence of tannic and gallic acids. They are indicated in the same kind 
of cases as, and under similar conditions to, the simple bitters; but they 
are supposed to have, in addition, some specific properties derived from 
their volatile and odorous constituents. 

Serpentaria is occasionally used as a stimulating tonic in typhoid 
and typho-malarial fevers. It is more frequently prescribed as a stimu- 
lant expectorant in capillary bronchitis, and in pneumonia of low 
grade, when carbonate of ammonia is combined with it. Formerly it 
was used locally to the throat, as a gargle in diphtheria, and given 
internally as a stimulant, but it is now very rarely employed in such 
cases. 

Wild-cherry is an excellent stomachic tonic, and may well be used 
as a substitute for calumba in the class of cases to which the latter is 
considered specially applicable. It has long been held in great esteem 
in domestic practice, as a remedy in catarrhal states of the bronchial 
mucous membrane, and in phthisis. Owing to the prussic acid which 
its cold infusion contains — produced by the reaction between the am3'g- 
daline and emulsine — it exercises some influence over cough. That it has 
any special virtues in the treatment of phthisis is hardly to be credited 
The sirup is much used as an ingredient in cough-mixtures. 

Authorities referred to : 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, Charles 
ion, 1869. 

Husejian, Drs. August und Theodor. Die PJlanzenstoffe. 
Fox, Dr. Wilson. The Diseases of the Stomach, 1872. 
United States Dispensatory, thirteenth edition. 



EUCALYPTUS. 153 

Eucalyptus. — Leaves of Eucalyptus globulus. 

Preparations. — Tinctura Eucalypti. Tincture of eucalyptus. Dose, 
3 ss— 3 ij. 

Extractum Eucalypti. — Extract of eucalyptus. Dose, gr. j — 3j. 

Eucalyptol. — Dose, m. v — 3 ss. Usually prescribed in capsules, 
but may be given in the form of emulsion. 

Composition". — Eucalyptus contains a peculiar resin composed of 
three different resinous bodies, a volatile oil consisting of eucalyptol, 
turpene and cymol, tannic acid, and a cry stall izable fatty acid. Euca- 
lyptol is the most important of the constituents. 

Antagonists and Incompatibles. — Alkalies, the mineral acids, the 
salts of iron, mercury, lead, zinc, etc., are chemically incompatible. 
All agents promoting waste, or the retrograde metamorphosis of tissue, 
are therapeutically incompatible. 

Synergists. — The simple and aromatic bitters, trydrastis, cinchona, 
etc., camphor, turpentine, cubebs, copaiba, the essential oils and sub- 
stances containing them, are synergistic to or promote the therapeuti- 
cal actions of eucalyptus. Any of these remedies may, therefore, be 
prescribed in the same formula with eucalyptus. 

Physiological Actions. — Eucalyptus has a warm, aromatic, bitter, 
and camphoraceous taste, resembling somewhat the taste of cubebs. 
In the mouth it excites the flow of saliva, and leaves a hot, pungent, 
and rather disagreeable flavor. In the stomach it causes a sensation 
of warmth, and doubtless promotes the flow of gastric juice. The 
appetite and digestive power are increased under its use. Increased 
intestinal secretion, also, is one result of its administration, and hence 
the alvine evacuations are rendered somewhat more copious and easy. 
In very large doses it causes a sense of weight and uneasiness at the 
epigastrium, odorous eructations and indigestion, followed by diarrhoea, 
the stools having the characteristic odor of eucalyptol. The essential 
oil is readily diffusible and enters the blood with facility, but what 
changes, if any, it induces in the blood are unknown. It increases the 
action of the heart, lowers the arterial tension, and induces a feverish 
state. The respiratory movements are accelerated. Wakefulness is 
caused by it in those of full health, and sleep in the weak and anasmic. 
The eucalyptol is eliminated by the skin, mucous membrane of the 
bronchial tubes, and by the kidneys, the secretions of these organs be- 
ing increased by it, and they are impregnated with its odor. This is 
especially the case with the urine, which after some days' administration 
becomes most strongly odorous by the presence of eucalyptol. 

The vapor of eucalyptus, inhaled in large quantity, produces analo- 
gous effects to the internal administration, besides the more decided 
effects on the bronchial mucous membrane. 

Eucalyptus is a powerful diaphoretic. 

Therapy. — The decoction of the leaves is an efficient local applica" 



154 RESTORATIVE AGENTS. 

tion in the various forms of stomatitis, angina subacute and chronic, 
and tonsillitis after the subsidence of the acute stage. 

Eucalyptus is one of the most useful of the so-called stomachics in 
atonic dyspepsia, chronic gastric catarrh, and chronic intestinal ca- 
tarrh, but its use is contraindicated in inflammatory states. The form 
of vomiting and indigestion, dependent on the presence of sarcina, is 
relieved by this agent, which acts by destroying the vitality cf this 
minute organism. That condition of the mucous membrane which 
favors the production of intestinal parasites is removed by eucalyptus. 
In the case of ascarides vermiculares, the remedy should be used by 
injection. 

Like the bitters, eucalyptus may be used to promote constructive 
metamorphosis, but it possesses more decided stimulant effects than 
these agents, by virtue of the eucalyptol. In convalescence from acute 
disease, in debility arising from defective assimilation, and in cachectic 
states generally, it is a serviceable tonic and stimulant. When the 
action of the heart is weak, it may be strengthened by eucalyptus. To 
women at the change of life who suffer from flatulence, palpitation of 
the heart, and sudden flushings of the face, it affords great relief, and 
often permanently removes these symptoms. 

Hysteria, chorea, asthma, and allied nervous states, when occurring 
in debilitated subjects, and cerebral anaimia, are benefited by eucalyp- 
tus. In asthma eucalyptus may be smoked in cigarettes with stramo- 
nium, belladonna, tobacco, etc. Its efficacy in the form of fumes is 
strongly stated by Maclean. 

The most important uses of this agent occur in the treatment of ca- 
tarrhal affections of the broncho-pidmonary mucous membrane. It 
is not adapted to acute affections or to recent inflammation, but to 
chronic cases accompanied by free muco-purulent expectoration. The 
author is able to confirm the observations of Gubler in reference to the 
great utility of eucalyptus in bronchorrhcea. It is an interesting fact, 
and probably explanatory of its therapeutical action, that eucalyptol is 
in part eliminated by the bronchial mucous membranes. In the same 
way eucalyptus is effective in the treatment of catarrhal states of the 
genito-urinary organs. Chronic desquamative nephritis, granular de- 
generation of the Jcidneys, pyelonephritis, and hydronephrosis, are im- 
proved by its cautious administration, but it should not be forgotten 
that, used too freely, or for too great a length of time, it will cause irri- 
tation and congestion of the kidneys, in the same way that turpentine, 
copaiba, and cubebs do. 

No remedy which the author has hitherto used has seemed to him so 
effective in chronic catarrh of the bladder as eucalyptus. The urine 
during its administration acquires a strong odor of eucalyptol, and to 
its local action on the mucous membrane is to be attributed the thera- 
peutical effect. 



HYDRASTIS. 155 

Eucalyptus has been much praised as a remedy for intermittent fe- 
ver. The evidence as to its utility is contradictory. As the result of 
his own observations, and after careful examination of the facts report- 
ed by others, the author concludes that eucalyptus is far inferior to qui- 
nine. It is certainly very serviceable in the convalescence from inter- 
mittent and remittent fevers, and in chronic malarial poisoning it 
has a high degree of utility. It cannot take the place cf quinine for 
the arrest of the paroxysms, or to prevent relapses at the septenary 
periods, but it is more useful than quinine to reconstruct the damages 
in the organs of assimilation caused by malarial infection. 

Externally, the tincture and the distilled water of eucalyptus are 
used as disinfectant applications to foul-smelling and ill-conditioned 
ulcers and wounds (Gimbert). The water of eucalyptus is recom- 
mended by Gubler, as a vehicle for agents used by the hypodermic 
method. The toxic influence of eucalyptus on the lower forms of life — 
cryptogamic and infusorial organisms — is the ground of its application 
for these purposes. As respects solutions of alkaloids for hypodermic 
use, the water of eucalyptus prevents the development o£ the penicillium, 
which grows rapidly and at the expense of the alkaloid in solutions 
prepared with simple distilled water. 

Authorities referred to : 

Burdel, Dr. E. Bulletin de Therapeutique, tome lxxxiv., p. 409, et ibid., tome lxxxv., 
p. 529. 

Costau, M. Gazette Hebdomadaire, 1872, No. 25. Bulletin de Tlierapeulique, tome 
Ixxxiii., p. 237. 

Gimbert, M. le Dr. Bulletin de Therapeutique, tome lxxxii., p. 422. 

Gubler, Dr. A. Bulletin de Thirapeutique, tome lxxxi., pp. 145, 193. 

Keller, Dr. The British Medical Journal, May 11, 1872. 

Lorinser, Dr. Wiener medizinische Wochenschrift, 1S69, xix., 43. 

Maclean, Dr. M. C. The Practitioner, vol. vii., p. 268. 

Schmidt's Jahrbucher der gesammten Medicin, vol. cxlviii., p. 11. Ueber Eucalyptus 
Globulus ; nach F. W. Lorinser ; C. Haller ; Franz Seitz ; L. A. Buchner ; C. Paul ; 
A. Gubler. 

Ibid. Vol. cl., p. 121. Ueber den Nutzen des Eucalyptus gegen Wecliselfieber. 

Hydrastis. — The Root of Hydrastis Canadensis. Yellow root. 

Preparations. — Extractum Hydrastis Fluidum. Fluid extract 
of hydrastis. Dose, m. v — § ss. 

Tinctura Hydrastis. — (Unoflicinal.) Dose, m. x — 3 j. 

Composition. — Hydrastis contains a peculiar principle, hydrastuie 
or hydrastia, which crystallizes in four-sided prisms, white or colorless 
when pure, and having but little taste. Hydrastine,the alkaloid, should 
not be confounded with the eclectic preparation, hydrastin, which is 
composed chiefly of berber-ine. Much of the peculiar virtues of hydrastis 
is probably due to the alkaloid berberine, which is contained in it in 



156 RESTORATIVE AGENTS. 

the proportion of about four per centum. Both of these alkaloids unite 
with acids to form salts. 

Antagonists and Incompatibles. — The alkalies, tannic and muri- 
atic acids, are chemically incompatible with the preparations of hydrastis. 
Muriatic acid precipitates berberine, and the so-called hydrastine of the 
eclectic practitioners is nothing more than berberine muriate. In pre- 
scribing the tincture and fluid extract of hydrastis with other bitters, 
only those free from tannin should be combined in the same prescrip- 
tion. 

Synergists. — The vegetable tonics in general are synergistic to 
hydrastis, especially berberis vulgaris and calumba, both of which 
contain berberine. 

Physiological Actions. — The preparations of hydrastis have a 
decidedly bitter taste, and, like other bitters, promote the flow of saliva, 
and probably, also, of gastric juice. Increased appetite and digestive 
power result from its administration. It is, therefore, a stomachic tonic. 
It also increases secretion of the intestinal mucous membrane — its 
glandular appendages — and, there are good reasons for believing, pro- 
motes the flow of bile. As a result of this increase of secretion, the 
stools become softer and more frequent under its use, and it has hence 
been stjded a laxative. The bodily condition, or constructive meta- 
morphosis, is promoted by its administration. On the nervous system, 
hydrastis, especially the alkaloid hydrastia, has effects somewhat alike, 
but less than those of quinine; but it appears to be devoid of toxic 
power. 

Therapy. — Stomatitis, both mercurial and aphthous, is much im- 
proved by local application of the fluid extract of hydrastis. When this 
preparation causes much smarting, it may be diluted with water. Fol- 
licular pharyngitis, chronic coryza, and even syphilitic affections of 
the mouth, throat, and nares, may be much benefited or even cured by 
the same application. It is said that five to ten drops of the fluid 
extract, taken by the stomach, will act favorably in the removal of the 
very troublesome affections named above, but the author is unable to 
verify these observations. 

Hydrastis is very useful as a stomachic tonic, and may take the 
place of calumba in the treatment of atonic dyspepsia. A few drops of 
the tincture or fluid extract (five to fifteen) taken before meals, daily, for 
some time, will often cure chronic gastric catarrh, and remove the dis- 
tressing headache which frequently accompanies this disease. It is one 
of the best remedies for the stomach catarrh of chronic alcoholism, and 
is probably the best substitute, if given in sufficient doses, for the alco- 
holic stimulant when its habitual use is to be abandoned. Catarrh of 
the duodenum is in a similar manner relieved by hydrastis, but this 
agent has special utility in duodenal catarrh when accompanied by 
catarrh of the gall-ducts and jaundice. Its use should, in these affec- 



HYDRASTIS. 157 

tions, be continued for some time. When a catarrhal state of the cystic 
duct — often resulting from or aggravated by catarrh of the duodenum 
— leads to inspissation of the bile and crystallization of the choles- 
terine, decided benefit accrues from the use of the preparations of hy- 
drastis. 

When constipation is dependent on deficient secretion, and the 
stools are dry and hard, it may be overcome by this remedy, but torpor 
of the muscular layer of the intestine is not affected by it. 

Chronic catarrh of the intestine, even when it has proceeded to 
ulceration, is sometimes remarkably benefited by hydrastis. When the 
stools are very frequent and there is much pain, it is advantageous to 
combine a little opium with it. In fissure of the anus, haemorrhage 
from the rectum, and ulceration of the rectal mucous membrane, appli- 
cations of fluid extract of hydrastis to the affected parts promote heal- 
ing. 

The alkaloid hydrastia may be used as a substitute for quinia in 
many of the conditions for which the latter is now so frequently pre- 
scribed, viz., to promote appetite and digestion, and to improve assimi- 
lation in cases of debility, in convalescence from acute diseases, in the 
various cachexia?, especially the paludal. 

As a remedy for inter mittents, hydrastia ranks next to quinia. It 
should be given under the same regulations as those which govern the 
administration of quinia, to the physiological and therapeutical action 
of which it is closely allied. The hydrastin of the eclectics, which is 
really muriate of berberine, is also a remedy of value in intermittents. 
The fluid extract of hydrastis contains, of course, both alkaloids. In 
chronic malarial poisoning (paludal cachexia), hydrastia and berberine 
may be given with ferruginous preparations, as quinia is so frequently 
employed. It exerts the same power, though less in degree, which qui- 
nia has over enlarged spleen of malarial origin. 

The preparations of hydrastis are used with advantage in certain 
affections of the genito-urinary organs. In chronic Erightfs disease, it 
appears to lessen the excretion of albumen. It diminishes the mucus 
in catarrh of the bladder. It is often the most efficacious remedy which 
we can employ in gonorrhoea after the acute stage has subsided, and in 
gleet. Especially in the latter has the author witnessed excellent re- 
sults from its employment. The local use of hydrastia, or of the fluid 
extract of hydrastis, should be conjoined with the internal administra- 
tion. The author has seen no injection so frequently successful in gon- 
orrhoea as hydrastia. JJ.. Hydrastia?, 3j; mucil. acacise, § iv. M. A 
half-ounce as an injection. Or the fluid extract, diluted to one-half or 
three-fourths with water, may be used for the same purpose. It is also 
a useful medicine in the treatment of spermatorrhoea, prostorrhoea, or 
urethral leucorrhcea. 

Uterine and vaginal leucorrhcea, xdcerations, and erosions of the 



158 RESTORATIVE AGENTS. 

cervix uteri, are quickly improved by the topical application of the 
fluid extract of hydrastis, which may be used in an undiluted state. 

Unhealthy and sloughing sores, chancroid, old ulcers of the leg, are 
improved in character by the local use of this remedy. To prevent 
septic decompositions in wounds or cavities communicating with the 
external air, it may be freely used by local application and injection. It 
has also been used, apparently with benefit, to the surface of cancerous 
growths / but the only influence it can have in this disease is to relieve 
fetor by preventing decomposition. 

Authorities referred to : 
Porcher, Dr. F. Peyre. Resources of the Southern Fields and Forests, Charleston, 

1869, p. 15. 
United States Dispensatory, thirteenth edition, articles Berberis and Hydrastis. 

CINCHONA AND ITS PREPARATIONS. 

Cinchona Flava. — Yellow cinchona (calisaya-bark). The bark of 
Cinchona calisaya. It should contain not less than two per cent, of al- 
kaloids, which yield crystallizable salts. 

■ Cinchona Pallida. — Pale cinchona. The bark of Cinchona condami- 
nea, and of Cinchona micrantha. 

Cinchona Rubra. — Red cinchona. The bark of Cinchona succirubra. 
It should contain not less than two per cent, of alkaloids, which yield 
crystallizable salts. 

Prepabations. — Decoctum Cinchonce Flavce. Decoction of yel- 
low cinchona (§ j — Oj). Dose, § ss — § j or more. 

Decoctum Cinchonce Hubrce. — Decoction of red cinchona (§ j — Oj). 
Dose, § ss — § j or more. 

Extractum Cinchonce. — Extract of cinchona (cin. flava). Dose, gr. 

j— x. 

Extractum Cinchonce Fluidum. — Fluid extract of cinchona. Dose, 
m. x — 3 j or more. 

Infusum Cinchonce Fiance. — Infusion of yellow cinchona (cinchona, 
§j; aromatic sulphuric acid, 3j; water, Oj). Dose, § ss — §ij. 

Infusum Cinchonce Hubrce. — Infusion of red cinchona (cinchona, 
1 j ; aromatic sulphuric acid, 3 j ; water, Oj). Dose, f ss — § ij. 

Tinctura Cinchonce. — Tincture of cinchona (yellow cinchona, § vj — 
Oij). Dose, 3 ss — 3 ij. 

Tinctura Cinchonce Composita. — Compound tincture of cinchona 
(red cinchona, § iv ; bitter orange-peel, § iij ; serpentaria, grs. ccclx ; 
alcohol and water, Oijss). Dose, 3 j — § ss. 

Cinchonice Sulphas. — Sulphate of cinchonia ; occurs in white shin- 
ing crystals ; dissolves in fifty-four parts of cold water, in much less 
boiling water, in seven parts of alcohol, and very sparingly in ether. 
Dose, gr. v — 3 ss. 



CINCHONA. 159 

Quinia} Sulphas. — Sulphate of quinia ; occurs in colorless, very 
light, and silky crystals ; is entirely dissolved by about seven hundred 
and forty parts of cold, or thirty of boiling water, is readily soluble in 
alcohol, and in water acidulated with sulphuric acid, but is insoluble in 
ether. Dose, gr. j — 3j. 

Quinice Valerianas. — Valerianate of quinia. A colorless salt, crys- 
tallizable, and having a peculiar odor and bitter taste ; is soluble in one 
hundred and ten parts of cold, or in forty parts of boiling water, and in 
six parts of cold alcohol. Dose, gr. j — 3j. 

Tilulce Quinice Sulphatis.— Pills of sulphate of quinia. Each pill 
contains one grain. 

Unofficial Salts of Quinine. — Kinate, tannate, citrate, acetate, tar- 
trate, phosphate, nitrate, hydrochlorate, arseniate, f errocyanate, picrate, 
etc. Salicylate of cinchonidia is a really useful addition to these 
salts. It has therapeutic property only second to the salts of quinia, 
and may be substituted for the latter in the treatment of malarial 
affections. 

Composition. — Cinchona is remarkable for the number and variety 
of the principles obtained from it, viz., five alkaloids, two simple acids, 
two tannic acids, and a resinoid substance. The most important alka- 
loid is quinia, which exists in all varieties of bark, but is most abun- 
dant in the yellow or calisaya bark. It occurs in combination with 
kinic and kino-tannic acids. Quinidia is an alkaloid isomeric with qui- 
nia, and may be used as a substitute for the latter in the same dose. It 
is less bitter than quinia, and its sulphate is more soluble in water. 
Cinchonia is found in greatest quantity in the pale barks. It unites 
with acids to form salts, of which the sulphate is most frequently used. 
Therapeutically considered, cinchonia has about half the strength of 
quinia. Cinchonidia is an alkaloid isomeric with cinchonia as quinidia 
is with quinia. Aricina, which has close analogies with cinchonia, has 
been found in the aricia or Cusco bark. 

The alkaloids are combined in bark with the acids kinic and kinovic, 
ohiefly with the former. There are also two kinds of tannic acid, Jcino- 
tannic and Mnovi-tannic, and a resinoid substance, Jcinovine. None of 
these have thus far been applied to therapeutical purposes, except kinic 
acid, which has been utilized to form a kinate of quinia, under the belief 
that a combination of qiiinia in its natural state would be more efficient 
as a remedy than as combined with a mineral acid. 

When the mother-liquor, left after the crystallization of the alkaloids, 
\s evaporated, a black residue is obtained, which is called chinoidine. 
This contains amorphous quinia and cinchonia, and probably also qui- 
nidia and cinchonidia. It is a very efficient anti-periodic, and may be 
used with advantage as a substitute for quinia, in doses about twice as 
large. 

With regard to the quantity of the alkaloids contained in the barks 



160 RESTORATIVE AGENTS. 

respectively, it may be stated that the three varieties — pale, yellow, and 
red — differ only in the relative proportions of their constituents. The 
pale bark contains most cinchonia, the yellow most quinia, and the red 
an equal proportion of each. 

Adjiinistration. — The alkaloids of bark are intensely bitter. Quinia 
being insoluble in the saliva, is less objectionable than its salts. The 
sweet principle of liquorice covers the taste of the cinchona alkaloids. 
A sufficient dose of quinia may easily be inclosed in a chocolate cara- 
mel. The sugar-coated pill, when freshly prepared and by a reputable 
maker, is a convenient and suitable form for administration; but by 
keeping it becomes hard and insoluble. The most active form is a solu- 
tion, the quinia being dissolved by the aid of sufficient dilute acid. For 
hypodermic use, the following formula may be followed: ]J. Quiniae 
sulphat., 3 j ; morphias sulph., gr. ss ; acid, sulphur, dil., m. xl ; aqufe 
destil., |j. M. Filter. Sig. Sixty minims contain seven and a half 
grains. Lente's solution is the following : J£. Quinia? bisulph., grs. 1 ; 
acid, sulph. dil., m. c ; aquae font., § j ; acid, carbol. liq., m. v. Solve. 
The quinine is dissolved by the aid of heat, and after filtration the car- 
bolic acid is added. 

Antagonists and Incompatibles. — Substances containing tannic 
acid in a free state should not be administered with the infusum or de~ 
coctum cinchonm. The preparations of iodine (tincture and compound 
solution) are also incompatible, for the} 7 form insoluble compounds with 
the cinchona alkaloids. The alkalies, alkaline carbonates, and alkaline 
earths, should not be administered with the solutions of the alkaloids, 
because the latter will be precipitated. 

As an agent promoting constructive metamorphosis, cinchona and 
its alkaloids are therapeutically antagonized by mercury, the iodides, 
the salts of copper, zinc, and lead. 

As Gubler has shown, morphia and quinia are antagonists in respect 
to their effects on the brain. As regards their action on the sympa- 
thetic system, on the heart, and on the temperature, quinia, and bella- 
donna and its alkaloid, are antagonistic. 

Synergists. — All those agents which promote constructive meta- 
morphosis, as the bitters, the ferruginous preparations, arsenic, and the 
acids, are synergistic to cinchona. 

Physiological Actions. — The preparations of cinchona are known 
as " astringent bitters : " they contain, in addition to bitter principles, 
two tannic acids. As bitters they act as stomachic tonics ; that is, pro- 
mote appetite, the flow of gastric juice, and the digestive power. Long 
continued, as is the case with all the other bitters, they set up a gastric 
catarrh', and digestion becomes painful and labored. They differ from 
the simple bitters in exercising an astringent action on the intestinal 
mucous membrane, and cause constipation. The red bark is more de- 
cidedly astringent than the yellow or pale bark. 



CINCHONA. 161 

Since the time of Sir John Pringle, who made the first experiments 
on this point, cinchona has been known to possess antiseptic properties. 
The powdered bark, applied to unhealthy wounds, arrests putrefactive 
decomposition, and promotes healing. The alkaloids are destructive 
of the minute organisms, on the presence of which fermentative 
changes depend, and hence, when added to milk, urine, and other ani- 
mal fluids, will prevent decomposition (Binz, Herbst, Baxter, etc.). 
Quinia, the most active of the alkaloids, is not equally destructive of 
all minute organisms ; some, it merely inhibits ; others, it kills. The 
bacteria of septic fluids resist its toxic action to a great extent, and 
are only inhibited by the largest quantity. 

When the crude bark is introduced into the stomach, the alkaloids 
are dissolved out by the acid gastric juice in which they are freely 
soluble. Any portion of the bark, or of the alkaloids, escaping solu- 
tion in the gastric juice, probably, passes out with the other unabsorbed 
contents of the intestine. The alkaline reaction of the intestinal 
juices will cause precipitation of the alkaloids, which, forming insol- 
uble combinations with the bile-acids, will not be absorbed. From 
the stomach the alkaloids diffuse into the blood with facility. In the 
alkaline blood, it is probable that the alkaloids are held in solution by 
the carbonic acid (Kerner). N'b changes visible by the unassisted 
eye are discernible in the blood, for, notwithstanding the observations 
of the older writers, who affirmed that the blood was dark, and unco- 
agulable, the moderns deny the existence of such alterations (Briquet, 
Schwalbe). Quinia acts in a definite manner on certain constituents 
of the blood — on the haemoglobin, impairing its power to transport 
active oxygen or ozone, into which the ordinary oxygen of the air is 
converted. This is demonstrated in the following manner : Mix with 
old turpentine, that is, turpentine long exposed to the air, and there- 
fore holding ozone, some tincture of guaiacum ; if, now, some haemo- 
globine or a drop of blood be added to the mixture, the tincture of 
guaiacum assumes a blue color, the change of color being due to the 
oxidation of the guaiacum by the active oxygen or ozone contained in 
the haemoglobin (Hermann). The addition of certain substances, no- 
tably of quinia, prevents the reaction ; in other words, destroys the 
ozonizing action of the blood. Binz has shown that so small a quan- 
tity of quinia as one part to twenty thousand exerts this action to a 
considerable extent. As soon as the blood is withdrawn from the 
peculiar influence exerted by the walls of the blood-vessels, as was 
some time ago shown by Pfliiger and Zuntz, its alkalinity begins to 
decline, and presently it exhibits an acid reaction. Correspondingly 
with the progress of this acidification, A. Schmidt has shown that the 
quantity of contained oxygen diminishes and the carbonic acid in- 
creases. These changes, leading finally to the death of the blood, are 
greatly retarded by the addition of quinia (Schulte, Binz, Ransone, 
12 



162 RESTORATIVE AGENTS. 

Kerner). From these observations we draw the conclusion that quinia 
lessens the oxidizing or ozonizing function of the blood. 

Binz and his pupils have shown that quinia inhibits or lessens the 
activity of the white blood-corpuscles, and indeed destroys them, or 
arrests their production ; for, in cats poisoned by this agent, the num- 
ber of white corpuscles was found to be considerably less than in un- 
poisoned animals (Scharrenbroich, Martin, Jerusalimsky, Geltowsky). 
By all the observers just named, by Baxter, who made a series of very 
carefully conducted experiments, and by Cutter, it has been estab- 
lished that quinia inhibits the amoeboid movements of the white cor- 
puscles. These bodies, as other masses of protoplasm, are in con- 
stant motion, changing their form and appropriating the materials 
of their nutrition. Such movements are called amoeboid, and they are 
arrested by quinia, even in so small a quantity as one part to four 
thousand ; hence it is called a protoplasmic poison. Quinia has also 
the power to prevent or arrest the migration of the white corpuscles 
from the vessels. This Binz was the first to demonstrate, using the 
method employed by Cohnheim for exhibiting the phenomena. This 
is now generally conceded, although denied by Schwalbe ; but, as the 
observations of Geltowsky show, the quantity of quinia necessary to 
produce the result varies with the animal experimented on, and ranges 
from one part in four thousand to one part in eight hundred, outside 
of the body (Appert). No amount, short of a fatal dose, can affect 
the movements of the white corpuscles in the living warm-blooded 
animal, according to Geltowsky, who, therefore, holds to the same view 
as Schwalbe on this point. In opposition to the views of Binz, must 
also be placed Schtschepotjaw, who has studied the effects of small 
quantities. 

Quinia also affects the rate of movement of the heart. An impor- 
tant distinction exists between the action of small and large doses. It 
is a matter of daily observation that ordinary medicinal doses of quinia 
(from two to five grains) increase the action of the heart, while ex- 
periments with large doses have demonstrated that this agent depresses 
the circulation. Observations on the intra-cranial circulation, as seen 
through the retina and drum membrane, have demonstrated that an 
artificial hyperemia results from the administration of medicinal doses. 
On the other hand, as Favier was the first to observe, quinia in 
large doses depresses the heart, arrests it in the diastole without im- 
pairing its contractility, and lowers the arterial tension (Chirone, Bri- 
quet). Quinia acts on the cardiac motor ganglia, and hence occur the 
feebleness of the heart's movements and in part the general lowering 
of the vascular tension (Lewizky). Besides these effects, it unquestion- 
ably depresses the vaso-motor system, after a short preliminary stimu- 
lation, probably (Jerusalimsky, Lewizky, Briquet). This depression 
of the heart from large doses occurs after the vagi are divided (Bri- 






CINCHONA. 163 

quet, Schlockow, Kohler, Lewizky), and is more conspicuous when the 
agent is introduced into the jugular vein, indicating that the impres- 
sion made on the heart is not through an increase of inhibition, but 
on the cardiac ganglia. Immersion of the heart in a quinine solution 
quickly arrests its movements. 

In the normal condition of the human subject, quinia does not 
appreciably affect the temperature. In the course of some carefully 
conducted experiments a few years ago, I found that the maximum 
doses caused not more than a half-degree decline in a healthy adult. 
In fever, however, the influence of antipyretic doses is prompt and 
decided. This result may be attributed to several factors : to the de- 
pression of the heart and arterial tension, to the suspension of the 
oxidizing power of the blood, and to the inhibition of the white cor- 
puscles. Jtirgensen was the first to observe that quinia prevented the 
rise of temperature produced by certain physiological acts, as, for ex- 
ample, active exercise, but Kerner has more particularly developed the 
experimental evidence proving this fact. By active gymnastics, the 
temperature was found to be elevated two to three degrees Centigrade ; 
but the previous exhibition of a full dose of quinia prevented this rise 
of the body-heat. . Kerner also ascertained that the increased cutaneous 
secretion, the result of active exercise, was prevented by the admin- 
istration of sufficient quinia. From all of these facts, it seems evident 
that the lowering of the temperature by this agent depends on dimin- 
ished production of heat rather than increased radiation and loss by 
cooling of the skin. This statement seems confirmed by the experi- 
ment of Lewizky, made in Hering's laboratory, by wrapping a rabbit 
in protective envelopes, to prevent loss of heat by cooling, and then 
practising the intra-venous injection of quinine ; the result was a de- 
pression of temperature as in animals not so enveloped. To such ex- 
periments, the author opposes the insuperable objection that the tem- 
perature in rabbits kept at rest declines, and to a remarkable extent, 
without the administration of any medicament. Nevertheless, the fact 
of the reduction of temperature by quinia is undoubted. By Popow, 
who admits the diminution of temperature, the influence of quinia 
over the body-heat is referred to some unknown biological process. 

In small doses quinia exerts a distinct stimulant effect on the 
cerebrum, increases the mental activity, and even exhilarates in some 
mobile constitutions. As some hyperemia is caused by it, the result- 
ing cerebral stimulation is probably secondary to this change in the 
vascular condition. In full medicinal doses, as the quinia accumulates 
in the brain, a sense of fullness in the head, constriction of the fore- 
head, tinnitus aurium, more or less giddiness, even decided vertigo, 
may be produced. Dullness of hearing results from considerable doses, 
and deafness has in rare cases been permanent. In a long experience 
of its use and extended observation, no case has come under my notice 



164 RESTORATIVE AGENTS. 

of permanently impaired hearing, although the temporary condition 
is usual. Amblyopia is a constant result of large doses, and amau- 
rosis has, it is said, occurred. The eminent oculist, Knapp, of New 
York, informs me that he has encountered several cases in which the 
retina was permanently damaged to a greater or less extent. In 
actually toxic doses all of the above symptoms have been intensified. 
There are intense headache with constriction of the forehead, dimness 
of vision or complete blindness, deafness, delirium or coma, dilated 
pupils, weak, fluttering pulse, irregular and shallow respiration, con- 
vulsions, and finally collapse and death. It is excessively rare to 
encounter such severe cerebral symptoms. 

The influence of quinia over the functions of the spinal cord is yet 
subjadice. Chaperon some time ago demonstrated that quinia lessened 
and ultimately abolished the reflex function of the spinal cord. This 
result he decided was due not to immediate action on the spinal cord, 
but to stimulation of Setschenow's centre of inhibition of reflex move- 
ments. Brunton, who has repeated Chaperon's experiments, has found 
them to be correct. The observation of Schlockow, that the first effect 
of quinia is to increase the sensibility of the reflex function of the 
spinal cord, has much probability in its favor. Heubach has, also, 
after moderate doses, observed some evidences of the existence of 
reflex irritability, but the experiments of Brunton show that these 
reflex effects decline with the increasing stimulation of the inhibit- 
ing centre. Brunton's experiments were, also, directed to ascertain 
whether the sulphuric acid in combination with the quinine was 
responsible for the effects observed, but the result proved that quinia 
is the active agent in stimulating Setschenow's inhibiting centre. 

As quinia depresses the functions of the sympathetic system, its 
action is opposed to that of agents which have the power to promote 
uterine contractions, hence, a priori, it would not seem to be aborti- 
facient. Very numerous and conflicting statements have been put 
forth, because there are no exact data. The few cases in which ute- 
rine action followed the administration of quinia were, doubtless, due 
to malarial intoxication or to other causes, and hence the association 
of uterine action with the effects of quinia was accidental. The innu- 
. merable instances in which quinia has been given during the existence 
of pregnancy, without initiating contractions of the womb, are cer- 
tainly conclusive against the view of its abortifacient power. While 
it is not a special uterine stimulant, it may exert such an action indi- 
rectly. "When uterine inertia is due to depression of the vital forces, 
quinia, in moderate doses, then becomes a valuable stimulant, and is 
utilized for this purpose in obstetric practice. 

The diffusibility of quinia and its rate and mode of elimination 
have been studied by Bence Jones, Ciotti and Albertoni, and Kemer. 
Jones in his researches availed himself of the fluorescent property of 



CINCHONA. 165 

animal tissues, possessed also in a high degree by the alkaloids of 
cinchona, especially quinia. To this substance, as it appears in animal 
tissues, Jones gave the name " animal chinoidin," but he was not 
aware that fluorescence is a property possessed by large numbers of 
animal and vegetable bodies. Nevertheless, he recognized the fact 
that the diffusibility of quinia could be estimated by the increase in 
the fluorescence of animal textures, and he thus ascertained that in a 
half-hour after the administration of quinia a positive gain in fluo- 
rescence of the crystalline lens is observed. It is probable that under 
some circumstances — a catarrhal state of the mucous membrane, for 
example — a portion of the quinia taken fails to be absorbed, and is 
consequently excreted by the intestines (Byasson). The effect of this 
agent on the secondary assimilation is involved in more or less doubt. 
Opposing opinions have arisen from the different points of view taken. 
In the normal condition quinia, in small quantity, stimulates the nu- 
trition, and increases the excretion of waste products — urea, uric acid, 
creatinine, extractives, etc. ; but, in considerable doses, the opposite con- 
dition obtains — the decrease in the quantity of uric acid is especially 
well marked (Ranke, Kerner) — and when administered in malarial 
fevers all the products of waste are greatly increased. The conditions 
attending the use of the remedy, therefore, influence the result. Con- 
siderable doses in the normal state diminish the excretion of urea; uric 
acid, creatinine, and phosphoric and sulphuric % acids (Kerner). Strass- 
burg, however, failed to find any change in the carbonic acid. Ac- 
cording to the observations of Cutler and Bradford, quinia has an 
obvious effect on the globular richness of the blood, increasing the 
relative proportion of the white, and diminishing the red globules. 
The action of quinia on the spleen is still sub judice. Piorry was the 
first to note a reduction in the size of the organ produced by quinia, 
but he had an exaggerated notion of the nicety by which a difference 
in the size of an organ could be made out by the plessimeter and ham- 
mer. Kiichenmeister examined the subject experimentally in 1851, 
with negative results, but afterward, operating with larger doses, ob- 
tained confirmation of Piorry's view. Hosier, after dividing all the 
nerves of the spleen, ascertained that quinia in large doses still acted 
on the contractile elements, and reduced the size of the organ. Jeru- 
salimsky, in an elaborate research, has established the same fact. That 
ihe enlarged spleen of malarial infection is reduced by quinia is an 
undoubted clinical fact. From these positive observations it must be 
concluded that quinia does act on the spleen, notwithstanding there 
are numerous negative statements. It follows, hence, that the dimi- 
nution in the red and increase of the white corpuscles may be due to 
this action. 

Quinia diffuses out of the blood into the urine, chiefly, but also 
into the sweat, saliva, milk, and pathological exudations (Kerner, 



166 RESTORATIVE AGENTS. 

Briquet, Binz). Jiirgensen found quinine in the urine in ten minutes 
after the hypodermatic injection. Thau had evidence of its presence 
in the urine in a half -hour after the ingestion of a half-drachm dose 
each by two persons, and he holds that the maximum elimination takes 
place in about eight hours, but the excretion is not completed until 
two days after the administration. According to De Renzi, quinia re- 
mains in the organism a variable number of days, and may indeed be 
discovered in the urine on the third day ; in a special case, as late as 
seven days. Binz also finds that the elimination of quinia is variable 
and rather slow, the maximum being excreted within forty-eight hours. 
From the time the agent appears in the urine, the systemic action is 
manifest, and the maximum effect of any given dose must be expe- 
rienced in advance of the period of maximum elimination, which Thau 
places at eight hours. According to Kerner, quinia appears in the urine 
in a somewhat modified form. 

The action of quinia has occasionally been attended by the appear- 
ance of an eruption on the skin. Sometimes the exanthem has been 
in the form of an erythema, sometimes it has assumed the appearance 
of urticaria ; again, it has seemed to be herpetic. There is, in fact, no 
constant and invariable eruption, and many of the reported cases are 
open to the suspicion that the appearances on the skin are merely acci- 
dental, and not causative. 

Therapy. — A solution of quinia will sometimes, when applied to 
the nares, arrest an attack of summer catarrh, a malady which appears 
to be produced by the pollen of plants. The preparation most suitable 
for this purpose is an aqueous solution of the hydrochlorate (gr. iv — 
gr. viij — § j). This should be applied by a large camel's-hair brush, 
or spray-producer, to the nares and fauces. The utility of quinine in 
this peculiar disease will be determined by the extent to which the 
local trouble has proceeded ; it can be useful only when the irritation 
is confined to the nares and fauces. 

The aphthous ulceration (muguet) which succeeds to an exhausting 
entero-colitis, or which occurs in cachectic infants, is much improved by 
quinia — a grain or two every three hours. An attack of acute tonsillitis 
may sometimes be aborted by a full dose of quinine (ten to fifteen grains). 
This practice is especially indicated in those cases which proceed to sup- 
puration, but the quinia must be administered before pus forms. 

The preparations of cinchona are much used as stomachic tonics. In 
atonic dyspepsia they are employed, like the simple bitters, to promote 
the flow of gastric juice. In gastric catarrh they relieve that morbid 
state of the mucous membrane on which the increased production of 
mucus depends. For these purposes they may be combined with the 
mineral acids. The best j)reparation i s the infusion ; the decoction, 
although official, is inelegant and faulty. The alkaloid quinia is fre- 
quently used for the same purposes, and notably in the gastric catarrh 



CINCHONA. 167 

of drunkards, combined with acids. When vomiting of ycast-like 
material is due to the presence of sarchut, quinia may be used in vir- 
tue of its power as a poison to these minute organisms, and as an anti- 
ferment. In these stomach-disorders other and less expensive drugs 
may be used with equal advantage. (See Hydrastis.) When there is 
a relaxed state of the gastro-intestinal mucous membrane, manifested 
by catarrh, diarrhoea, etc., but without inflammation, the preparations 
of red hark are more particularly indicated in virtue of the tannins 
which they contain. The reader need hardly be reminded that the 
preparations of cinchona are contraindicateel in all inflammatory states 
of the intestinal mucous membrane. Furthermore, if too long con- 
tinued, they will set up an irritation, and perpetuate the troubles which 
they were prescribed to remove. 

Sometimes it happens that the entero-colitis of children (cholera 
infantum), which resists every possible combination of astringent and 
laxative, will yield readily to quinia. The author has seen quinia give 
prompt relief in the following : A child suffers with tenesmus, and 
after much straining voids a transparent mucus streaked with blood, 
but there is no fever nor other disturbance of the bowels, and the 
stools when passed are natural. 

The preparations of cinchona and quinia are very serviceable in 
that state of the mucous membrane which favors the development of 
ascarides. After the expulsion of the parasites, these remedies remove 
the saburral state of the mucous membrane. A combination of purga- 
tives and bitters will correct the following condition of things as they 
occur in children : A foul breath, coated tongue, capricious appetite, 
tumid belly, and constipation alternating with diarrhoea. 

The use of quinia as a restorative tonic in cases of debility is almost 
universal. Given in moderate doses — six to twelve grains a day — it 
promotes constructive metamorphosis. Its utility is due not to any 
direct action on the blood, but to its stimulant effect on the digestive 
function, and the retardation of the combustion process. When cin- 
chona or quinia proves irritant to the intestinal mucous membrane, this 
heneticial restorative action ceases. Iron and arsenic increase the power 
of quinia to promote construction of tissue and to retard waste. 

There can be no doubt in regard to the power of quinia to arrest 
the inflammatory process in its formative stages. Its utility, given 
with this view, ceases when the migration of the white corpuscles and 
the proliferation of the cellular elements of the inflamed parts have 
taken place, for it possesses no power to cause disintegration and ab- 
sorption of inflammation products. Administered at the critical mo- 
ment, a commencing fibrinous pneumonia, a pleuritis, an endocarditis. 
may be suppressed by a full dose (twenty to forty grains). Its power 
in this respect is much increased by combination with morphia. If the 
time have passed for the use of quinia in this way, it is employed with 



168 RESTORATIVE AGENTS. 

advantage as a restorative tonic in the various inflammatory affections 
of low type, small doses (two to four grains) being given frequently. 

In septic diseases quinia has very important uses. Although the 
observations of Binz, showing the influence of quinia over septic pro- 
cesses, may not be applicable to the full extent for which he proposes 
them, there can be do doubt of the good effects in practice of quinia 
in septicaemia, pyaemia, erysipelas, and puerperal fever. In these dis- 
eases, only large doses — five to twenty grains — every four hours, are 
useful. 

The author's experience in the treatment of acute rheumatism does 
not justify the use of large doses of quinia, as now employed by Bri- 
quet and his followers in France. In the hyperpyrexia of acute rheu- 
; matism, it is true, large doses of quinia will depress the temperature, 
but we have less distressing and more effective means for accomplishing 
this object, in the wet-pack and the cold bath. When the acuter symp- 
toms have subsided, and the skin is cool and perspiring, and the pulse 
weak, quinia in moderate doses — two to five grains — is very serviceable. 

A careful examination of the large number of facts which have now 
been accumulated and considerable personal experience and observa- 
tion, have satisfied the writer of the inutility of quinine, in the treat- 
ment of typhus and» typhoid fevers. Not only has this remedy no 
influence over the course and duration of these affections, but its irritant 
effects upon the gastro-intestinal mucous membrane, and its inhibitive 
influence, exerted through the organic nervous system, upon the heart 
and lungs, render it positively injurious in large doses. As a rule, the 
dryness of the tongue, the diarrhoea, the subsultus, and the delirium 
of typhoid fever, are increased by it. In certain parts of the United 
States, the prevalence of a mixed type — typo-malarial — requires, under 
certain conditions, the use of quinia in continued fevers. But it be- 
comes less and less effective as the typh-element predominates. When 
there are evidently true remissions — and not merely the rhythmical 
morning remission and evening exacerbation characteristic of typhoid 
— quinia is indicated, and it is most effective when administered in an 
occasional large dose during the remission. When there is a condition 
of hyperpyrexia, or of continuously elevated temperature, which endan- 
gers life by parenchymatous degeneration and cardiac or cerebral paral- 
ysis, quinia in antipyretic doses renders an incontestable service. This 
opinion of the author is fully confirmed by the committee of the Clini- 
cal Society of London, who find that large doses of quinia have a 
marked effect in reducing the temperature in pyrexia, and that, although, 
with the exception, perhaps, of certain cases of rheumatic fever in which 
the temperature is high, no decided evidence has been obtained to show 
that quinia has any influence in shortening the attack of a specific dis- 
ease such as typhus or scarlet fever, yet from the marked effect on the 
temperature and pulse there is reason to believe that at the critical stage 



riNcno.VA. 169 

of acute disease, when pulse and temperature are high, a large dose of 
qoinia may be employed with benefit Jtirgensen, Ringer, Lieber- 
meister, and other authorities, and a vast clinical experience in all civ- 
ilized countries, are now agreed in respect to the fever-reducing power 
of quinia and to the absence of ill results from large doses (especially 
Liebermeister). Liebermcister, indeed, says, if he were restricted in his 
choice to one antipyretic, he would select quinia. The quantity neces- 
sary to effect a decided reduction of the body-heat in fevers is deter- 
mined by the age, the amount of disturbance, and the individual sus- 
ceptibility to its action. In general, it may be stated that from twenty 
to sixty grains will be required. The antipyretic effect is more decided 
if it is [riven toward the close of the exacerbation or during the remis- 
sion in typhoid or other fevers. The duration of the effect is " from 
one to forty-eight hours ; " consequently, a repetition of the dose will 
be necessary, if it is desired to maintain the reduction of the tem- 
perature. A few large doses at short intervals until the necessary 
quantity is reached, or a single maximum dose if the stomach is tol- 
erant, should be prescribed, rather than a succession of smaller doses. 
The rapidity with which elimination takes place is a sufficient reason 
for adopting the former mode of administration. The effect of quinia 
is not less happy in the fevers of childhood, and comparatively large 
doses are well borne at this period, as Jacobi, especially, has shown 
us. The same rule should be followed as in the case of adults : to 
give the amount required in several doses within a brief period — an 
hour, according to Liebermeister — or at one time. The antipyretic 
use of quinia should not be confounded with its tonic or supporting 
qualities. In the treatment of fevers, the typhoid state, or the con- 
dition of adynamia supervening during the course of fever, small doses 
(two, three, or four grains), at short intervals, are employed for the 
stimulating effect which they have on the organs of circulation, res- 
piration, and digestion. Large doses, as has been set forth, depress 
these functions. 

In cerebrospinal meningitis, doubtless a continued fever with cere- 
brospinal lesions, quinia is indicated under the conditions already de- 
fined for the treatment of other inflammations, viz., in the beginning 
of the disease, when the alterations of cutaneous sensibility first occur, 
and before the febrile movement has developed. If a few large doses 
— twenty to thirty grains — do not produce a good result, it is useless 
to repeat them, or to pursue a tentative plan with small doses. 

In the treatment of the eruptive fevers., variola, scarlatina, rubeola, 
quinia has an important place. It is used in small doses, frequently 
repeated in adynamic states, and in large doses at longer intervals to 
reduce hyperpyrexia. In scarlet fever, Dr. Hood especially urges the 
use systematically of quinia from the earliest stage of the disease, pre- 
ceded by an emetic and purgative, and he states as the result of this 



170 RESTORATIVE AGENTS. 

practice that since he has adopted it he has not lost a single case of 
this disease treated by him from the beginning. In measles, large doses 
of quinia have an unquestionable utility in relieving the catarrhal 
pneumonia, and in preventing those changes in the exudation products 
which end in caseation. 

The most important uses of quinia are those which, in the present 
state of our knowledge, cannot be deduced from a study of its physio- 
logical actions, viz., the cure of malarial diseases. It is true, the 
toxic action of quinia on minute organisms is supposed by Binz and 
his followers to be the true explanation of its methodus medendi, but 
the exact influence of these organisms in the causation of malarial 
diseases has not hitherto been defined. The recent discovery of the 
bacillus malaria} by Klebs and Tommasi-Crudeli, if confirmed, will 
afford the needed explanation. The power of quinia to render inactive 
the minute organisms of disease must also be exerted against the ma- 
laria-germ. Other agents possess this power, it is true, but they are, 
unlike quinia, destructive of the tissues as well as of the disease-germs. 

The alkaloids of cinchona are employed as prophylactics against 
malarial infection. The experience of the English naval service, of 
crews engaged on the coast of Africa in the suppression of the slave- 
trade, of the expeditionary force into Ashantee under Lord Napier, and 
of our late civil Avar, has abundantly shown that quinia is in a high de- 
gree prophylactic. The first public reference to this property seems to 
be that of Dr. Bryon in 1854, who called attention to the success which 
attended its use among the crews of the British vessels serving on 
the coast of Africa. Since that time, for several years the statistical 
reports of the British naval medical service have contained conclusive 
evidence on this point. Dr. Joseph Jones has published since the close 
of the civil war some valuable statistical data, showing the efficiency 
of quinia as a prophylactic. The troops who were the subjects of ex- 
periment were stationed in a highly malarious locality. Of the num- 
ber, 230, who took no quinia, 134 had fever. Of those who took quinia 
irregularly, 246 in number, 96 had fever. Of the 506 who took quinia 
regularly, 98 had fever. The proportion of cases of fever was, there- 
fore, 1 to 5.66 men. On the coast of Africa, the proportion has varied 
from 1 in 8 to 1 in 20. Of the unprotected, more than one-half — on the 
coast of Africa, three-fourths — were attacked by malarial disease in 
some form. As the quantity of quinia daily taken has been usually 
three to five grains, it is probable that the results would be even more 
favorable if a larger quantity of the prophylactic were given. When 
the poison is not intense, this amount may be sufficient, but if concen- 
trated and active, and the conditions are otherwise unfavorable, twice 
as much should be administered daily. An enormous experience has 
now shown that quinia is entirely free from injurious effects when taken 
as a prophylactic. It is probable that the influence slowly decreases, 



CINCHONA. 171 

and that some addition to the daily quantity may be necessary after a 
time. The prophylactic dose should be administered on rising in the 
morning, and may be usefully prescribed in a cup of black coffee, or in 
pill-form. The practice adopted in the civil war, of giving whiskey as 
the vehicle, is not to be commended. If the quinia administered fail 
to prevent the disease, those attacked will suffer far less severely than 
the unprotected. Experience has shown that, to be entirely efficient, 
the quinia must be administered for some time, at least ten days, after 
exposure to the causes of fever (Jones). 

The mode of using quinia for the cure of intermittents may be 
formulated as follows : 

The antipyretic is nearly equally effective whether administered in 
the interval or during the seizure. 

If time is an element of importance, no delay is necessary in order 
to give the remedy in the stage of apyrexia. 

To save the suffering and exhaustion of the febrile movement, the 
attack should be anticipated, and, if possible, prevented. 

As the maximum effect of the quinia is attained in about five hours 
after being taken, it should be administered this period of time, at least, 
before the expected paroxysm. . 

As the elimination of quinia takes place with considerable rapidity, 
the maximum curative effect is obtained by the administration of the 
whole amount required in a single dose, rather than by a succession of 
small doses (Prize Essay). 

An intermittent may be successfully treated by giving, during the 
interval, a number of small doses frequently repeated. The author is 
convinced by extended observation that a full dose of quinia (ten 
grains) in the sweating stage, and the same quantity five hours before 
the time of the next paroxysm, is the more effective method. The 
anti-periodic property of quinia is increased, and the cerebral effects 
of large doses diminished by combination with morphia. It is well 
known that intermittents, arrested by quinia or other anti-periodics, 
manifest a tendency to recur about the septenary periods ; therefore, 
ten to fifteen grains of quinia should be administered in anticipation of 
these recurrent paroxysms, until the third septenary period has passed. 
Meanwhile, the organs damaged by the malarial infection — intestinal 
canal, liver, spleen, kidneys, etc. — require appropriate treatment. The 
action of quinia is much assisted by the continuous administration of 
arsenic during the intermissions, and until the third septenary period 
has passed. The unpleasant cerebral effects of quinia are lessened or 
prevented by the simultaneous administration of diluted hydrobromic 
acid: r>. Quiniae sulph., 3 j ,' acid, hydrobromic. dil., fss; aquae, 



iss. M. Sig. One or two teaspoonfuls at a dose. 



In the treatment of remittent fever two modes of using quinia are 
employed : first, by emetics, purgatives, baths, diaphoretics, etc., to 



172 RESTORATIVE AGENTS. 

secure a distinct remission when the remedy is administered ; second, 
to give it in sufficient dose immediately, relying on its apyretic effect. 
The author is convinced that the latter plan is preferable : from twenty 
to thirty grains in a single dose once or twice each day until the tem- 
perature is reduced to normal. This use of the remedy need not inter- 
fere with other appropriate medication. 

In the so-called pernicious fe ver, it is agreed on all hands that the 
safety of the patient is secured only by the prompt use of large doses 
(twenty to sixty grains), and administration by the stomach, rectum, 
and skin, may be in turn or simultaneously resorted to. 

In chronic malarial infection, important changes have been pro- 
duced in the intestinal canal, liver, spleen, kidneys, cerebro-spinal axis ; 
the paroxysms of fever occur irregularly ; various abnormal manifesta- 
tions of the infection take place (dumb ague, enlarged spleen, etc.). 
Under these circumstances, quinia is less curative than when the infec- 
tion is recent, and the paroxysms will recur from time to time notwith- 
standing its use, unless these structural alterations are corrected. In 
chronic malarial disease, salicylate of quinia and salicylate of cincho- 
nidia are especially effective. $ . Cinchonidise salicylat., 3 ij ; acidi 
arseniosi, gr. j; ferri sulph. exsic, 3j. M. Ft. pulv. (wafers) no. xx. 
Sig. One three times a day. Also: IJ. Chinoidin., 3 ij; quinia? salicylat., 
3 j; ferri sulph. exsic, 3 j. M. Ft. pil. no. lxxx. Sig. Two pills three 
times a day. IJ. Quinise sulph., chinoidine, hydrastise, aa 3 j; res. po- 
dophylli, gr. x; ferri sulph. exsic, 3 ss. M. Ft. pil. no. lx. Sig. Two 
pills three times a day. 

In periodical affections of malarial origin, quinia is equally as effec- 
tive as in the periodical febrile diseases, but somewhat larger doses are 
necessary. A difficulty of diagnosis often arises in these diseases, for 
the reason that the neuroses are irregularly periodical in their mani- 
festations, when not malarial in origin. The existence of a malarial 
cachexia, and the more uniform periodicity in the recurrence of the 
paroxysms, will enable the practitioner to distinguish the neuroses of 
malarial origin from the other functional disorders of the nervous 
system. The following group contains the disorders of the sensory 
nervous system caused by malaria : tic-douloureux, cephalalgia, cer- 
vico-brachial neuralgia, cervico-occipital neuralgia, dorso-intercostal 
neuralgia, lumbo-abdominal neuralgia, mammary neuralgia, crural neu- 
ralgia, gastralgia, enteralgia, hepatalgia, nephralgia, hysteralgia, ova- 
ralgia, sciatica, angina pectoris. 

The following motor disorders, also, are produced by malarial influ- 
ences : epilepsy, chorea, stricture of urethra, hiccough, laryngismus 
stridulus, asthma, summer catarrh. 

These neuroses may occur as an expression of malarial infection, 
being substituted for the ordinary chill, fever, and sweat, or they may 
assume the orderly periodical character in consequence of having oc- 



CINCHONA. 173 

curred in an organism, already under the influence of the malarial 
cachexia. If they are of malarial origin, the specific action of quinia 
will speedily prevail against them. These malarial neuroses require 
large doses of quinia, and the same fact is true of all irregular mani- 
festations of malarial infection. Ten to twenty grains, according to 
the severity of the attacks and the obstinacy with which they recur, 
are necessary, and the paroxysms should be anticipated by the exhi- 
bition of the remedy from three to five hours before the expected time. 
In cases of malarial neuralgia, the curative effect of quinia is enhanced 
by combination with morphia, either in the same prescription or by 
simultaneous administration of the latter subcutaneously. 

Diarrhoea, dysentery, jaundice, and hypertrophy of the spleen, oc- 
casionally occur in the periodical form, or are due to the immediate 
influence of paludal miasm. Under these circumstances quinia affords 
relief without the use of any other remedy. Very frequently the di- 
arrhoea, dysentery, and jaundice, are results of structural alterations in 
the liver, and the glandular apparatus of the intestine, and are not 
merely functional disorders which quinia may remove. In malarial 
enlargement of the spleen, quinia is supposed to be especially effective ; 
but quinia exhibits a curative power only in cases of simple enlarge- 
ment, and does not affect that condition known as " fleshy spleen," or 
chronic splenitis. 

Hematuria when distinctly intermittent, and arising from malarial 
infection, is cured by quinia, but large doses are necessary. 

Cases of cerebral disease, occurring in weak and anaemic subjects, 
are sometimes much improved by small doses of quinia. The author 
has observed great relief by the use of this remedy in the following 
group of symptoms, occurring in men advanced in life : Headache, ver- 
tigo, f ailure of memory, and despondency, associated with a slow pulse, 
an atheromatous degeneration of the vessels, pufliness of the eyelids, 
and dilatation of the superficial veins of the head. From three to ten 
grains daily may be given with advantage, the effect being to remove 
that sluggishness of the intra-cranial circulation on which these symp- 
toms depend. In insanity, especially the puerperal form, when there 
is much weakness, and the skin is cold. and sweating, quinine is very 
useful. When there is a condition of adynamia — the usual state — in 
delirium tremens, small doses of quinia assist materially in tranquil- 
lizing the patient. In that preliminary stage known as "horrors," 
characterized by restlessness, tremor, nausea, and anorexia, quinia, with 
a mineral acid, renders important service by restoring the digestive 
function, and by giving steadiness to the cerebral motor centres. 

Although headache (hemicrania) and neuralgia of malarial origin 
are cured by quinia, by no means equally successful results follow the 
use of this remedy in ordinary headache and neuralgia. Quinia is 
largely employed, it is true, in these affections when not caused by 



174 RESTORATIVE AGENTS. 

malai'ia, but it is useful only when anaemia is present and is causative. 
The same remark is true of epilepsy and chorea. 

An attack of acute catarrh may often be entirely aborted by a full 
dose (ten grains) of quinia and morphia (one-half a grain), if given at 
the incipiency of the attack. After the acute symptoms haVe subsided, 
quinia is very serviceable in hay-asthma. Diphtheria being an ady- 
namic disease, quinia is used by the stomach with a view to its restora- 
tive action, and in the form of spray to arrest the spread of the exuda- 
tion in the fauces. The power of quinia to kill bacteria and micrococci 
renders its local use a rational measure in a disease characterized by an 
enormous multiplication and diffusion of micrococci. 

Laryngismus stridulus, a reflex spasm of the muscles of the larynx 
occurring in rickety, ill-fed, and anaemic children, may be prevented 
recurring by the use of quinia in the intervals between the attacks. 
Quinia is one of the remedies which is used in membranous croup, but 
the reported successes were probably cases of spasmodic croup. There 
can be no doubt regarding the good effects of quinia in asthma, after 
the severity of the paroxysms has somewhat abated, as an apyretic in 
the fever which succeeds, and as a restorative tonic. It is, also, the most 
useful tonic Avhich can be employed in chronic bronchitis, with profuse 
expectoration (bronchiectasis). The hectic fever and sweats of phthisis 
are prevented by large doses (fifteen to twenty grains) of quinia, but 
this remedy really has no influence over the course and progress of the 
disease. 

In skin-diseases, when there is present a lowered condition of the 
vital forces, quinia is indicated. It is the most valuable remedy in 
erysipelas and erythema nodosum. It is a curious fact that in many 
subjects a full dose of quinia will cause an erythema, with dilated 
pupils, phenomena closely analogous to those produced by belladonna. 
Ecthyma and impetigo, usually arising in a feeble state of the assimi- 
lative functions, are cured by quinia. 

Quinia is largely employed in surgical affections, to sustain the 
powers of life during protracted suppuration, and to check the forma- 
tion of pus. It is the most generally prescribed remedy for surgical 
fever. A full dose of quinia, given before the operation, may prevent 
the chill and fever which succeed in some subjects to the operation of 
catheterization. 

Subcutaneous and Local Uses of Quinia. — The increasing use 
of quinia hypodermatically requires further consideration of this sub- 
ject. In pernicious intcrmittcnts and remittents, when life is put in 
imminent danger, the most speedy and effectual way of introducing 
the remedy must be employed. Besides the hazai'ds due to the inten- 
sity of the poison, an irritable stomach and rectum prevent the intro- 
duction of the remedy by either of those channels. The subcutaneous 
method then becomes most important. Again, in obstinate and re- 



CINCHONA. 175 

peatcdly relapsing intermittent*, the introduction of the remedy by 
the skin imparts to it greater curative power. In enlarged spleen 
(ague-cake), malarial jaundice, with great irritability of the stomach, 
and a catarrhal state of the gastrointestinal mucous membrane, the 
subcutaneous method becomes necessary, or, if not essential, is much 
more effective. Quinia and the sulphate simply suspended are not 
adapted to subcutaneous use. Several cases of tetanus have been 
reported from New Orleans (Sale), and two cases occurred in one 
regiment of the British Indian Army from their use in this way, 
The salt employed for hypodermatic use should be sufficiently solu- 
ble that no undissolved particles be thrown under the skin. Vari- 
ous solutions have been proposed. The muriate is more soluble than 
the sulphate — dissolves in twenty-four parts of cold water, and about 
three parts of alcohol. One grain will dissolve in about fifteen min- 
ims of hot water, and in a much less quantity of aleohol-and-watei-, 
but alcohol is irritating. Lente's solution, which is much employed 
in New York, is prepared as follows : 1$. Quiniae disulph., grs. 1 ; acid, 
sulphuric, dil., m. c ; aquas font., 3 j ; acid, carbolic, liq., m. v. Solve. 
This contains six grains to the drachm. Dr. Lente directs that the 
quinia and water be heated to the boiling-point when the acid is 
added. The solution is then filtered into a bottle and the carbolic acid 
added. Below 50° Fahr. it must be warmed before using. A solution 
of kinate of quinia is much used at Guy's Hospital at the strength of 
one to four. The kinate is obtained by decomposing sulphate of quinia 
with the kinate of barium. The mode of preparing the solution is as 
follows : Put into a beaker 3 vj of distilled water and 3 ij of kinate 
of quinia, and heat until the salt dissolves, which it does almost imme- 
diately, and then add enough distilled water to make up to 3 j. The 
disadvantage of so concentrated a solution is the incrustation, by evap- 
oration, of the bottle and syringe with the solid kinate. The sulpho- 
vinate of quinia is very soluble — one part in three of water at 60° 
Fahr. — and is readily prepared by double decomposition between the 
alcoholic solutions of sulpho-vinate of sodium and sulphate of quinia. 
Gubler advocates the hydrobromate, as follows : IJ.. Quiniae hydrobro- 
mat., grs. xlviij ; aquae destil., 3 iv. M. Dissolve by heat if necessary. 
Five minims contain one grain. 

Recently a new compound salt of urea and quinia has been pro- 
posed, and it seems to possess distinct advantages over every other 
preparation : it is designated quinia bimuriatica carbamidata, and is 
formed by Drygin from a combination of twenty parts of muriate of 
quinia, twelve parts of muriatic acid, and three parts of urea. The 
resulting salt is soluble in equal parts of water. The utility of this 
compound is not entirely theoretical. Practical trials made at Ham- 
burg have demonstrated its fitness for hypodermatic use. A fifty-per- 
cent, solution has usually been employed, and a half to three syringefuls 



176 RESTORATIVE AGENTS. 

(m. xv to 3 jss) injected. The local irritation is represented as slight. 
Very favorable reports have been published in respect to the utility of 
the hydrobromate brought forward by Gubler. In the hands of Ray- 
mond, Soulez, and others, intermittents are said to have ceased after 
two injections of three grains each of this salt. The usual method 
pursued was to inject one and a half grain of the hydrobromate twice 
morning and evening, and, although six to twelve grains were usually 
successful, in one case thirty grains were required. It has also been 
employed in the treatment of acute rheumatism. 

Quinine in solution is applied in various affections of the fauces by 
atomization. In diphtheria especially have good results been produced. 
A saturated solution of the muriate or of the bromide may be thus 
employed. There can be no doubt that a solution of quinia applied 
to the nares may be very beneficial at the onset of hay-asthma, as 
first shown by Hehnholtz. The author has seen several cases benefited 
greatly ; but to achieve success the applications must be thorough and 
timely. The secret of any good effects it has, is afforded by its toxic 
action on germs, and possibly on the pollen of certain grasses, to the 
presence of which the irritation of the air-passages is ascribed. As 
soon as the first symptoms are experienced, the mucous membrane 
should be cleared of mucus by means of a nasal syringe, throwing a 
solution of common salt, muriate of ammonia, or chlorate of potassa, 
and then the quinia solution should be applied by a camel's-hair brush 
to the anterior nares, or by the post-nasal syringe to the whole canal. 

Authorities referred to : 

Appert Dr. J. Virehovi's Archiv, Band lxxi., p. 364. Der Einfluss des Chinin auf 
die Auswanderung der weissen Bluikbrper bci der EntziXndung. 

Bartholow Dr. E. Russell Prize Essay — On Quinine, Hartford, 186S. 

Baxter Dr. E. Buchanan. The Practitioner, London, November, 1873. The Action 
of the Cinchona Alkaloids on Bacteria, etc. 

Binz, Prof. Dr. Carl. Papers on the Actions of Quinia in Virchow's Archiv, Band 
xlvi., pp. 67 and 129; in the Bcrl. Min. Wochcn., No. 46, p. 556, and Nos. 47, p. 564, and 
48, p. 575, 1871 ; and in Archiv fur cxpmimcntelle Pathol, und Pharmacol, vol. i., p. 18, 
and vol. vii., p. 275. 

Briquet, Dr. Traiie Therap. du Quinquina, Paris, 1855; and Bull. Gen. de Tlierap., 
vol. lxxxiii., p. 289. 

Brunton, Dr. T. Lauder. St. Bartholomew's Hospital Reports, vol. xii. On the In- 
fluence of Quinine on the Reflex Functions. 

Btasson, Dr. H. Journal de Therapeutique, vol. xiv., p. 526, 1880. £tude sur Elim- 
ination par les urines des quatre alcaloides principaux de quinquina, ingeres a Veiat de 
sulphates basiques. 

Chirone, Dr. Vincent. Gazette Hcbdomadaire, 1875. Mechanisme de taction de la 
quinine sur la circulation. 

Ciotto and Albertoni. Bull. Gen. de Tlierap., May 15, p. 430, and August 30, p. 360, 
for 1876. Sur les voies d' 'elimination et d 1 action elective de la quinine. 

Colin, Dr. Leon. Bull. Gen. de Therap., July 15 and 30, 1872. £tude sur les sels 
de quinine, de lew action physiologiques et medicate. 



CINCIIONA. 177 

Cutter and Bradford. The American Journal of the Medical Sciences, October, 1878, 
p. 367. 

Geltowsky, Dr. The Practitioner, June, 1872. On the Action of Quinine on the Col- 
orless Blood- Corpuscles. 

Herbst, Dr. U. Diss. Bonn. Virchow und HirsclCs Jahrcsbericht. Beilrage zur Kennt- 
niss dcr anliseptischen Eigenschaftcn des Chinins. 

Heubach, Dr. Central, fur dicmed. Wissensch., 43, 673, Virchow und Nirsttis Jahrcs- 
bericht, vol. i., 1874. Also, Archiv fur experimcntelle Pathol, und Pharmacol., vol. v. 
Einwirkung des Chinins auf das Nervensysicm. 

Jerusalimsky, Dr. Nic. Ueber die physiologische Wirkung des Chimin, Berlin, 1875, 
p. 89, pamphlet. 

Karamitsas, Georges. Bull. Gen.de Therap., August 15 and 30, 18S0. SurThamia- 
turie provoquec par Ic quinine. 

Kerner, Dr. G. Archiv f. d. gcs. Physiologic, etc., Band vii., p. 122. Ueber den Ein- 
fluss des Kristallischen und des amorphen Chinins auf die weissen Blulkorperchen. Also, 
Beilrage zur Kenntniss der Chininresorplion. Ibid., 1870, p. 366. 

Kohler, Dr. H. Quoted by Virchow und HirsclCs Jahresbericht for 1876, vol. i. 
Ueber die Wirkungen des Chinin. 

Lewizky, Dr. P. Virchoio's Archiv, Band xlviii., p. 352. Ueber den Einfuss des 
Schwelfelsauren Chinins auf die Teniperalur und Blutcirculation. 

Liebermeister, Dr. C. Archiv fur hlin. Med., iii., pp. 21, 569. Ueber die antipyre- 
tische Wirkung das Chinins. Also, Handbuch der Path, und Therap. des Eiebers, p. 634. 

Martin, Dr. Adolph. Das Chinin als Antiphlogisticum, Giessen, 1868. 

Pantelejeff, Dr. S. London Medical Record, October 15, 1S80. On the Antagonism 
of Quinia and Morphia. 

Papow, Dr. Virchow und Hirsch's Jahresbericht, 1876, vol. i. Kritische und experi- 
mented Untersuchungen zur Thcorie der temperalurherabsctzenden Wirkung des Chinins. 

Ransone, Dr. R. Ueber ei.nige Beziehungen des Chinin zum Blute, 1871. Diss. 
Bonn. 

Renzi, Dr. Bull. Gen. de Therapcutique, vol. xci., p. 45. Observations sur V elimina- 
tion du sulfate de quinine par V urine. 

Ringer, Dr. Sydney. Various papers in the London Lancet, British Medical, and 
Journal of Physiology. 

Scharrenbroich, Dr. C. Berliner klinische Wochenschrifi, 16, 1872, p. 190. Das 
Chinin als Antiphlogisticum. 

Schroff, C. v. J. Medz. Jahrb. Virchow und Hirsch, Beitrdge zur Kenntniss dcr Chi- 
ninwirkung. 

Schtschepotjaw, Nic. Archiv f. d. gesammte Phys., xix., p. 52. Virchow und Hirsch's 
JahresbericM, 1878, vol. i. Selbstandige Contraction der Eerzsputze Vcranderungen der 
Muskeln und dcr weissen Blutkbrperchen unter den Einfuss von Chinin. 

Schulte, Dr. A. Diss. Berolini, Virchow und HirscA's Jahresbericht, vol. i., 1871, p. 
349. 

Schwalbe, Dr. C. Deutsche Klinik, 36, 325, 1868. Ueber die Eniziindungswidrige 
Wirkung des Chinin. 

Strassburg, Dr. Gustav. Archiv fur experimentelle Pathologie und Pharmacologic, 
Band ii., p. 334. Ueber die Auscheidung der Kohlensdure nach Aufnahme von Chinin. 

13 



178 AGENTS INCREASING WASTE. 



AGENTS PROMOTING DESTRUCTIVE METAMORPHO- 
SIS OR INCREASING WASTE. 

ALKALIES. 

Potassium. — Preparations: Potassa. — Potassa; potasse, Fr. ; Kali 
hydrlcum, Ger. Caustic potash. Occurs in cylindrical rods, is very 
deliquescent, and dissolves in water and in alcohol. 

Potassii Acetas. — Acetate of potassium. A white deliquescent salt, 
wholly soluble in water (100 in 35) and in alcohol (proof spirit 1 in 2). 
Dose, grs. v — 3j. 

Potassil Plcarbonas. — Bicarbonate of potassium. In white crystals, 
permanent in the air, wholly soluble in water (1 in 3), and having a 
slightly alkaline taste. Dose, grs. v — 3j. 

Potassii Carbonas. — Carbonate of potassium. A deliquescent salt, 
wholly soluble in water (100 in 75). Dose, grs. ij — grs. x. 

Liquor Potassii Citratis. — Solution of citrate of potassium. Dose, 

3 j— Si- 

Potassii Citras. — Citrate of potassium. A whitish, granular, deli- 
quescent salt, wholly soluble in water (10 in 6). Dose, grs. v — 3 ss. 

Potassii Tartras. — Tartrate of potassium. In white crystals, which 
are somewhat deliquescent, and are wholly and readily soluble in four 
parts of boiling water. Dose, grs. v — 3j. 

Potassii et Sodii Tartras. — Tartrate of potassium and sodium — Ro* 
chelle salt. In colorless, transparent crystals, which effloresce slightly 
in dry air, and are wholly and readily soluble in five times their weight 
of boiling water. Soluble in cold water, 1 in 2. 

Liquor Potassa?. — Solution of potassa. A colorless liquid, having 
an extremely acrid taste, and a strong alkaline reaction. Dose, m. ij — 
m.xx. It should be taken well diluted with water. 

Potassii Chloras. — Chlorate of potassium. In colorless, tabular 
crystals, which have a pearly lustre, and are wholly soluble in distilled 
water (in cold water, 1 in 12 ; in boiling water, 1 in 2). Dose, grs. v 

Trochisci Potassii Chloratis. — Chlorate of potash troches. 

Potassii Nitras. — Nitrate of potassium. In colorless, prismatic crys- 
tals, unalterable in the air, and wholly soluble in water (in cold water, 
1 in 4 ; in boiling water, 1 in 2-J-). Dose, grs. ij — grs. x. 

Potassii PicJiromas. — Bichromate of potassium. In orange-red, 
anhydrous, tabular crystals, soluble in ten parts of cold, and in much 
less of boiling water, forming a solution having an acid reaction. Dose, 
gr. \— gr. ss. 

Potassii Bitartras. — Is sparingly dissolved in cold water (1 in 200), 
more freely in boiling water (1 in 18). Dose, 3 j — 3 ss. 



ALKALIES. 179 

Antagonists and Incompatible. — The alkalies and their carbon- 
ates are incompatible with the acids and with metallic salts. Tbe 
caustic alkalies decompose the alkaloids of belladonna, stramonium, 
hyoscyamus, duboisia, etc. In case of poisoning, the antidotes to be 
employed are — acetic, citric, or tartaric acids, in the form of vinegar, 
cider, lemon-juice, etc. Demulcents and the fixed oils limit the cor- 
rosive action of the caustic alkalies, and should therefore be given 
freely. 

Synergists. — The alkalies assist each other's action. All agents 
promoting waste — for example, mercury, the iodides, etc. — increase the 
therapeutical activity of the alkalies. 

Physiological Actions of the Potash Salts. — The most recent 
experiments having shown that potash has quite distinct properties 
from the other alkalies of the group, each member of the group is con- 
sidered separately. As an alkali, potash combines with acids to form 
salts, and with fats to form soaps. As it has a great affinity for moist- 
ure, and dissolves albumen, and is a very diffusible substance, it exerts 
a destructive action on tbe animal tissues. These chemical facts ex- 
plain the active caustic properties of potassa fusa. In the stomach the 
salts of potash obey chemical laws, neutralize the free acid, and sapon- 
ify oily or fatty matters. Given when the stomach is empty, potash, 
as do the alkalies in general, promotes the acidity of the gastric juice, 
by increasing the osmosis of those constituents of the blood from 
which the acid of the stomach is elaborated ; but, as a large amount 
of alkali will neutralize a corresponding proportion of acid, it is obvi- 
ous that, to obtain an increased quantity of acid gastric juice, the 
amount of alkali administered must be small and rightly timed. 

"When a toxic dose of potassa, of the carbonate, nitrate, or chlorate, 
is taken, violent local inflammation results. The action and the ap- 
pearances are somewhat different as regards potassa and its salts. 
The former liquefies the tissues, and extends its escharotic action 
widely and deeply, the sloughs being surrounded by a zone of inflam- 
mation. The salts, according to their activity and the quantity taken, 
set up a high degree of inflammation, cause intense burning pain about 
the epigastrium, nausea, vomiting, sometimes of bloody mucus, purg- 
ing, the stools being watery and profuse, or they may be dysenteric. 
In the case of caustic potash, marks of corrosive action, sloughs of the 
mucous membrane, bloody cozing, may be seen about the lips, mouth, 
and fauces, and shreds of bloody and sloughing tissues vomited. In 
case of toxic action of potassa and its salts, the local destruction, pain, 
and inflammation, are accompanied by the usual systemic symptoms — 
great depression of the powers of life, a weak, rapid pulse, shrunken 
countenance, cold surface, followed by coma and insensibility. In a 
small proportion of cases the local mischief is not great, but the effects 
of the poison are expended on the nervous system, and assume the 



180 AGENTS INCREASING WASTE. 

form of muscular weakness, paralysis of the inferior extremities, weak 
action of the heart, and coma, and a very large dose may cause death 
suddenly by paralysis of the heart before the local inflammation has 
time to develop. The nitrate and chlorate are the most active of the 
salts, but all potash bases have more or less power in the same direc- 
tion. The well-known case of Dr. Fountain, of Iowa, illustrates some 
points in the action of chlorate of potassa. Entertaining some theo- 
retical notion of the curative power of this remedy when administered 
in considerable doses, he took an ounce to demonstrate its innocuous- 
ness. Violent gastro-enteritis was produced ; at first there was free 
diuresis, but urinary suppression followed, and death ensued in seven 
days after the ingestion of the poison. When recovery takes place 
after poisoning by caustic potash, deformity of the mouth, stenoses of 
the oesophagus, cardia and pylorus, may remain, and then, after a par- 
tial improvement, the mechanical interference with the functions of 
these organs causes a more or less rapid marasmus. 

When the alkaline bicarbonates are taken on an empty stomach 
they diffuse quickly into the blood, where, meeting the neutral phos- 
phate of sodium, they are decomposed, acid phosphate of sodium being 
formed, and this compound, diffusing out of the blood into the urine, 
increases the acidity of that excretion (Rolfe). The result is different 
when bicarbonate of potassium is taken during digestion, for then, the 
reaction of the gastric juice being strongly acid, this salt is decomposed, 
carbonic acid is given off, and the alkaline base lessens the acidity of 
the stomach, increases the alkalinity of the blood, and diminishes the 
acidity of the urine. The salts of potash formed with vegetable acids 
undergo conversion into alkaline carbonates in their passage through 
the organism, and are eliminated in this form, thus causing an alkaline 
condition of the urine. The period of administration unquestionably 
influences the result to a large degree, as has just been stated. The 
increased alkalinity of the blood, produced by the administration of 
the potash salts, promotes its oxidizing function (Buchheim, Basham, 
Kohler, and others). The relative quantity of uric acid is diminished, 
and of urea increased. Basham, instructed by the observations of 
Schunck, that oxalurate of ammonia is a product of the oxidation of 
uric acid, and that the former is readily converted into urea and oxalic 
acid, holds that the same process takes place in the organism when 
uric acid is subjected to the action of the potash salts. The urine of 
patients suffering from uric-acid deposits was carefully examined 
after a course of the citrate or carbonate of potassium, and it was 
found, after an interval of about three days, that the urea was in one 
case trebled in amount, and in others more than doubled, while the uric 
acid was reduced to a fractional part of what had existed (Basham). 
The facts, then, are conclusive in regard to the increase in the oxida- 
tion processes, caused by the administration of potash, and its salts 



ALKALIES. 181 

formed by combination with carbonic and the vegetable acids. The 
changes in the fatty constituents of the blood consist, probably, in a 
process of saponification, and excretion. Nitrate and chlorate of po- 
tassium produce very different effects on the blood. Not parting 
with their oxygen in the system, and excreted undecomposed, the 
effects noted in the blood must be due to their action as a whole. The 
changes made by the chlorate in the composition of the blood have 
been studied recently by Marchand, in cases of poisoning in man and 
by experiments on animals. The blood assumes a dark, brownish, or 
chocolate color, and can no longer take up oxygen ; the haemoglobin 
is decomposed, and the injured blood-corpuscles accumulate in the 
spleen ; the kidneys are brownish in color, and the tubules are choked 
with the broken-down materials of the red globules. The peculiar 
brownish color of the blood is found, by spectroscopic analysis, to 
be due to a substance identical with Hoppe-Seyler's methaemoglobin. 
These effects separate the chlorate, nitrate, and other compounds of 
potassa very distinctly from the compounds with vegetable acids, 
while the latter also differ distinctly from the former in the power to 
alkalinize the blood and urine. 

A very considerable reduction of temperature is produced by 
large doses of the potash salts (Podcopaew, Guttmann, Traube). 
This effect, due especially to chlorate and nitrate of potassium, may 
be readily explained by the changes in the haemoglobin, which impair 
its function as a carrier of oxygen. Ordinary doses do not affect tem- 
perature decidedly, probably because they do not have the power to 
change the properties of haemoglobin. The alterations produced in 
the composition of the blood by the salts of potash necessarily affect 
the nutritive functions. The increased elimination of urea, the waste 
of the fatty constituents of the blood and of the tissues, the more 
rapid process of oxidation, results of the action of the potash salts, 
necessarily place these remedies among the list of those promoting 
destructive metamorphosis. 

Drs. Ringer and Murrell find chloride of potassium to be a proto- 
plasmic poison, and to this effect they refer its action on the brain and 
nervous system and on the heart. That potash is a poison to the heart 
has long been known. The experiments of Podcopaew, repeated sub- 
sequently by Guttmann, confirm this. Whether introduced directly 
into the circulation, by injection into the jugular vein or subcutane- 
ously, the paralysis of the heart follows — more speedily, when the 
poison reaches the heart more directly. The arrest of the heart takes 
place in the diastole, and occurs after division of the pneumogastric, 
whence it must be concluded that the effect on the heart is not exerted 
through increase of the inhibition. As, when a large dose is suddenly 
precipitated on the heart, its movements are speedily arrested, and the 
muscle of the heart does not then respond to electrical excitation, the 



182 AGENTS INCREASING WASTE. 

effects of the poison must be expended chiefly on tbe muscular tissue 
(Traube), but not wholly so, since, before the electro-contractility is 
entirely abolished, all motion may be arrested. The cardiac ganglia 
must therefore participate in the changes wrought by the poison. The 
effect of potash on the tension of the vessels — on the blood-pressure — 
is much influenced by the quantity and mode of administration. A 
large quantity by intra-venous injection quickly poisons the heart and 
lowers the pressure in the arterial system. On the other hand, small 
doses increase the tension (Hummel, Traube). As elimination takes 
place very rapidly, it is not surprising to find that the normal pressure 
is quickly restored. This difference in the result, due to the size of 
the dose, is largely responsible for the conflicting statements which 
have been put forward. 

It has been ascertained by Ringer and Murrell, and by Guttmann, 
that the contractility of the muscles and the irritability of the motor 
nerves persist after complete paralysis induced by the potash salts. 
The paralyzing action must, therefore, be exerted on the spinal cord. 
In fact, as Ringer and Murrell have shown, potash, being a protoplas- 
mic poison, affects most injuriously the most highly specialized struct- 
ui'es ; hence the brain and spinal cord suffer earlier and more severely 
than do other tissues. Valentin has made some very interesting com- 
parative observations on the effects of tbe chlorides of the alkalies, 
when frogs are immersed in solutions of these salts. In a ten-per-cent. 
solution of chloride of ammonium, the frogs died in two or three min- 
utes ; in the chloride of potassium and lithium solution of the same 
strength, death occurred in ten minutes ; in chloride of sodium solu- 
tion, in ten to twenty-five minutes ; and in chlorides of calcium and 
barium solutions, also of the same strength, death ensued in the course 
of thirty minutes. Besides the cutaneous irritation, the effects were 
similar to those already mentioned, except the changes in nerve and 
muscle reactions, the result doubtless of imbibition. The early sus- 
pension of the reflexes, the fibrillary trembling of the muscles, and 
the loss of electro -contractility almost at once, indicate the local action 
of the poison. 

The elimination of the potash salts takes place by various channels, 
chiefly by the kidneys, but they also appear in the saliva, sweat, milk, 
and other secretions. The effect of these salts on the reaction of the 
urine and the differences in result due to the period of administration 
have been pointed out. The state of acidity of the stomach greatly 
affects the reactions of the urine produced by the carbonates of po- 
tassa (Ralfe). The salts of vegetable acids undergo decomposition in 
their passage through the system ; they render the urine alkaline, and 
greatly increase the excretion of free carbonic acid (Parkes). The 
after-condition of the urine is that of increased acidity (Ralfe). The 
nitrate and chlorate of potassa are eliminated unchanged, and do not 



ALKALIES. is; 

affect the reaction of the urine (Laborde). The notion entertained in 
some quarters that chlorate of potassa parts with its oxygen, is en- 
tirely erroneous. These salts increase the amount of urinary water, 
and, in common with the other members of the family, promote oxi- 
dation and the excretion of urea. "While the acetate increases the dis- 
charge of urinary water, it actually lessens the quantity of solids 
excreted (Parkes). The production of saliva is much increased by the 
chlorate, which is freely eliminated by the salivary glands (Laborde). 
It is a very important fact, which we owe to Dr. Jacobi, of New York, 
that chlorate of potassa irritates the kidneys, and if continued a suffi- 
cient time sets up a chronic nephritis. Others have made similar ob- 
servations, so that the popular use of this supposed harmless agent 
should be discouraged by the medical profession. 

Therapy of the Potash Salts. — Chlorate of potash is in almost 
universal use as a remedy for catarrhal inflammation of the month 
and fauces, for acute tonsillitis, aphthous ulcerations of the mouth, 
stomatitis materna, or nursing sore-mouth, and mercurial stomatitis. 
As above stated, the domestic use of this remedy for sore-mouth and 
sore-throat has become an evil which should be discouraged. For or- 
dinary purposes this remedy should not be employed. The utility of 
the chlorate is, however, so decided in the case of stomatitis materna, 
that all other considerations are merely secondary. In this malady 
large doses (fifteen grains to 3 j three or four times a day) are neces- 
sary, and a less amount will fail to effect a cure. In mercurial stoma- 
titis, ulcerative tonsillitis, diphtheritic angina, etc., the following for- 
mula maybe applied locally : I£. Potassa? chlorat., 3 j ; acid, carbolic, 
3 ss ; glycerini, 3 j ; aqua?, 3 iij. 31. Sig. Lotion. 

The potash salts are used with great advantage in many stomach- 
disorders. It is an undoubted chemical fact that an excess of aciel is 
relieved by an alkali, but the result is not permanent, and the cause of 
the acidity is not removed. Small doses of an alkali, given with a 
bitter before meals, promote the flow of gastric juice, and are a ser- 
viceable combination in atonic dyspepsia. IJ. Inf. calumba?, 3 iv ; 
liq. potassa?, 3 ss. M. Sig. A dessert to a tablespoonful three times 
a day before meals. Administered after meals, the alkalies will relieve 
the acidity due to ah excessive production of acid, or to the acid fer- 
mentation of the starch, sugar, and fat, in the food. An acid given 
before meals is the proper remedy for the excessive formation of the 
acid of the gastric juice. Alkalies render an important service in case 
of indigestion of fats. Xot only do they prevent the formation of 
butyric acid, but they assist in the pi-ocess of emulsionizing the fats 
and help their absorption. In diseases of the liver, and when from 
any cause the flow of bile into the intestine is prevented, alkalies assist 
in the digestion and absorption of fats. The indigestion of obese sub- 
jects, and of the gouty and rheumatic, is usually cured or alleviated. 



1S4 AGENTS INCREASING WASTE. 

by alkalies. The lithia salts are generally to be preferred in gouty 
and rheumatic subjects ; but, generally speaking, the bicarbonate of 
potassium is the most useful of the alkali remedies in the above-men- 
tioned maladies. 

The salts of the alkalies, especially the citrates, tartrates, and car- 
bonates of potassium, are useful in inflammatory diseases to lessen heat, 
and to promote excretion of the products of inflammation. When 
oxidation is deficient, as represented in an excess of uric acid in the 
urine, a coated tongue, hebetude of mind — the so-called "bilious state " 
— relief is afforded by the use of the alkalies and their laxative salts. 
The alkaline treatment of acute rheumatism is based on these princi- 
ples. Although this plan of treatment may not be adapted to all 
cases, there can be no doubt of its utility in respect to a considerable 
proportion. It must be borne in mind, as Dr. Fuller, the most influen- 
tial advocate of the method informs us, that the alkaline treatment 
consists in a plan, made up in part of the use of bicarbonate of potas- 
sium, and in part of certain adjuvants, notably quinia. The main 
point in the treatment consists in the administration of remedies to 
induce an alkalrnization of the system as quickly as possible, for when 
this is accomplished further joint and heart complications are not like- 
ly to occur. Fuller gives not less than an ounce and a half of bicarbon- 
ate of potassium, largely diluted with water, in the first twenty-four 
hours of the treatment. Sometimes this salt is given in effervescence 
with lemon-juice — in the proportion of two drachms to an ounce of 
lemon-juice — every three or four hours, or with citric-acid solution. If 
the bowels are torpid, one or more compound cathartic pills are pre- 
scribed in addition. As soon as the urine ceases to exhibit an acid 
reaction — usually at the expiration of twenty-four hours — the quantity 
of potassic carbonate is reduced one-half. If the urine continues alka- 
line at the expiration of another period of twenty-four hours, the alkali 
is further reduced one-half, and, on the fourth day, the same conditions 
continuing, the treatment ceases to be exclusively alkaline. Then the 
alkali is reduced to the amount necessary merely to keep the urine 
neutral — about a half -drachm of the bicarbonate three times a day, 
and quinia is given. In Dr. Fuller's words, three grains of quinia dis- 
solved in lemon-juice, is given three times a day in effervescence with 
half a drachm of bicarbonate of potash. In ninety-four cases of acute 
rheumatism thus treated, the average duration, from the beginning of 
treatment, was eleven days. This method is adapted to the treat- 
ment of the plethoric, obese, and muscular subjects, and in the experi- 
ence of the author is not well suited to the pale, delicate, and ana?mic 
rheumatic. 

In irritation of the urinary organs due to an excess of acid, the 
combinations of potash with the vegetable acids possess a high degree 
of utility. The liquor potassse is much prescribed under these circum- 



ALKALIES. 185 

stances, but, as it is very irritating to the stomach, the salts are prefer- 
able, and they are equally effective. The liquor potassse citratis is an 
excellent form for this purpose. There is no doubt that the long-con- 
tinued use of alkalies (citrate, acetate, and carbonate of potassa) will 
effect the solution of renal calculi, which are usually composed of uric 
acid. As the urate of soda is often the nucleus of these formations, the 
soda alkalies should not be used. Small doses taken daily for length- 
ened periods are necessary. Such alkaline waters as the Vichy may 
be used if more agreeable to the patient, but the best results are ob- 
tained by the administration of the citrates and tartrates in a large 
quantity of distilled water. "When the urine is acid in any of the forms 
of cystic irritation — from stone, cystitis, stricture, enlarged prostate, 
etc. — great relief is experienced from the use of alkalies, notably the 
liquor potassse, the citrates, acetates, and carbonates of potassium. 
"When the urine is alkaline in reaction, no benefit can be derived from 
the use of these remedies. 

The bitartrate and the acetate of potassium are very certain (Hu- 
rt tics, especially the first named. They are most effective when given 
largely diluted with water. A pleasant form in which to administer 
cream of tartar is the familiar " cream-of -tartar lemonade," made as 
follows : A sufficient quantity of the remedy is dissolved in hot water ; 
when cold the clear solution is poured off ; some lemons are cut up and 
put in it, and it is sweetened to the taste. This solution may be drunk 
ad libitum. Considerable stomach and intestinal distress often follows 
the free use of dilute solutions of these potash salts, in consequence of 
the abundant production of carbonic-acid gas. The potash salts are 
indicated as diuretics in desquamative nejihritis, and in general dropsy 
from reticular disease of the heart. By determining a free urinary 
discharge in the one case, they assist in washing out the obstructing 
epithelium in the tubules ; in the other, they relieve the tension of the 
venous system. Very little is accomplished by the use of alkaline 
diuretics in dropsical accumulations in the various cavities. 

Sodium. — Soda. — Soda ; Natrium, Ger. ; soude, Fr. Occurs in ir- 
regular flat masses. Is soluble in water and in alcohol. 

Liquor Sodce. — Solution of soda. A colorless liquid, having an ex- 
tremely acrid taste, and a strong alkaline reaction. Dose, m. ij — m. x. 

Sodii Acetas. — Acetate of soda. In white or colorless crystals, 
which effloresce in dry air, and are wholly soluble in water. Dose, 
grs. v— 3 j. 

Sodii Bicarbonas. — Bicarbonate of sodium. A white opaque pow- 
der, wholly soluble in water (1 in 10). Dose, grs. a - — 3 j. 

Sodii JBoras. — Borate of sodium. Borax. In colorless crystals, 
which slightly effloresce in dry air, and are wholly soluble in water. 
Dose, grs. ij— 3j. 



186 AGENTS INCREASING WASTE. 

Sodii Carbonas Exsiccata. — Dried carbonate of sodium. Dose, 
grs. ij— grs. x. 

Sodii Carbonas. — Carbonate of soda. Dose grs. v — 3]. 

Sodii JVitras. — Nitrate of soda. Dose, 3 j — § j. 

Sodii Suljihas. — Sulpbate of soda. Glauber's salts. Dose, § ss — 

Pulveres Effervescentes. — Effervescing powders. Each powder con- 
tains thirty grains of bicarbonate of sodium in one paper, and twenty- 
five grains of tartaric acid in the other paper. 

Pulveres Effervescentes Aperientes. — Aperient effervescing pow- 
ders. Seidlitz powders. Each powder contains forty grains of bicar- 
bonate of sodium, and one hundred and twenty grains of tartrate of 
potassium and sodium (Rochelle salt) in one paper, and thirty-five 
grains of tartaric acid in the other paper. 

Antagonists, Incompatibles, and Syneegists, are the same as 
those given under potassium. 

Physiological Actions of the Salts op Sodium. — In respect 
to the merely alkaline properties, there is a close correspondence be- 
tween potassium and sodium, but as regards other properties there is 
a wide divergence. The salts of soda are alkaline, and hence neutral- 
ize the acid of the gastric juice. They are readily diffusible. Like 
the potash salts, they increase the alkalinity of the blood, and under 
suitable conditions determine a change in the urine from acid to alka- 
line. The same results follow the administration during or between 
the intervals of digestion, as in the case of the potash salts. The 
alkalinity of the urine induced by soda salts ceases on the day follow- 
ing their administration, and the acidity is then increased. Soda has but 
little toxic action besides the local caustic effects. Caustic soda, like 
caustic potash, dissolves albumen, forms soaps with fats, and destroys 
the tissues widely and deeply. It is, however, less active than caustic 
potash. The composition of the blood does not appear to be altered 
by the salts of soda in any reasonable quantity. Laborde, in some 
comparative experiments between chlorate of potassa and chlorate of 
soda, finds that the latter, in treble the quantity of the former, has but 
a transient effect, depressing the temperature a half -degree, and caus- 
ing a slight salivation, but producing none of the paralytic symptoms 
which follow the administration of the potash salts. Guttmann had 
previously demonstrated the same facts, and Schonlein, in some stud- 
ies with the carbonate, finds that even in large doses in frogs it rarely 
arrests the heart's movements, only slowing and lengthening the con- 
tractions. Chloride of sodium has, unquestionably, an important office 
in the economy. It forms the principal part of the soluble constitu- 
ents of the ash of all animal substances. Aibumen owes its solubil- 
ity in part to the chloride of sodium ; it dissolves pure caseine, and 
impedes the coagulation of the fibrine of the blood. In one thousand 






ALKALIES. 187 

parts of blood there are about four parts of this salt. It is very abun- 
dant in various normal secretions and pathological products. The 
gastric juice is very rich in chloride of sodium, and it probably is the 
source of the hydrochloric acid of the stomach (Lehmann). In the 
course of an inflammation, notably of pneumonia, the chloride of so- 
dium of the system accumulates in the inflamed area, and disappears 
from the urine. Its return to the urine is in the nature of a critical 
phenomenon, and marks the subsidence of the inflammation. The im- 
portance of this salt in the animal economy is doubtless the cause of 
the universal taste ; all in excess of the needs of the body is excreted, 
chiefly by the kidneys, and with such facility that no accumulation 
takes place. "While a necessary amount is of high importance and 
excess is readily disposed of, it is probable that long and habitual in- 
dulgence in a considerable excess increases waste and lowers the vital 
forces. 

Therapy of Sodium Salts. — The most important salt of soda — 
the phosphate — has been considered under the head of phosphates. 
The soda salts are to be preferred in the alkaline treatment of stomach- 
diseases, but the potash salts when it is desired to promote oxidation 
in the system, or to alkalinize the urine. The urate of soda is insol- 
uble. In case of excess of acid, or acid indigestion, the use of soda 
after meals is very effective ; but, while the immediate result is good, 
the after-effect is to increase the production of acid. Those who 
habitually take sodium bicarbonate for acid indigestion suffer severely 
from acidity. Taken before meals, or on an empty stomach, soda-bi- 
carbonate is useful in atonic dyspepsia, to increase the acid of the 
gastric juice. Acute indigestion, with vomiting, especially if the vom- 
ited matters are very acid, and there is burning at the epigastrium, may 
be quickly relieved by the effervescing powder. The acid diarrhoea 
of children is relieved by the bicarbonate of sodium. This salt may be 
utilized as an emetic in narcotic stupor when other emetics fail to act. 
The author has known this method to succeed in opium narcosis. A 
half to a drachm of bicarbonate in solution in water is swallowed or 
thrown into the stomach by the pump, and this is followed imme- 
diately by a similar quantity of tartaric acid. Brisk effervescence 
ensues, and the contents of the stomach are evacuated. In intussus- 
ception, the same expedient has been practised with success. The 
solution of bicarbonate of sodium is thrown into the rectum, and is 
followed by the acid. Strong pressure must be made on the anus ; the 
gas forces the bowel back through the ileo-csecal valve and thus re- 
lieves. A stomach or bowel much softened by inflammation, or weak- 
ened by ulceration, is a contraindication of such an expedient. 

In the treatment of the febrile state, and to lessen the acidity of 
the urine, the soda salts have been proposed as substitutes for the pot- 
ash salts. The researches of Laborde, Guttmann, Podcopaew, and 



1S8 AGENTS INCREASING WASTE. 

others, have shown that the former do not have the same powers as 
the latter, and that therefore the substitution cannot be made success- 
fully. 

Calcium. — Calx. — Lime ; JTalk, Ger. ; cliaux, Fr. 

Caleii Carbonas Prcecipitata. — Precipitated carbon of calcium. 
A fine, white powder, insoluble in water. Dose, grs. v — 3 j. 

Creta Prceparata. — Prepared chalk. Dose, grs. v — 3j. 

Liquor Calcis. — Lime-water. 

Liquor Calcis Saccharatus. — Dose, 3 ss — 3 ij (unofficial). 

Testa Prmparata. — Prepared oyster-shell. Dose, grs. v — 3j. 

Mistura Cretm. — Chalk-mixture. Dose, 3 j — 3 ss. 

Caleii Chloridum. — A colorless or whitish salt, sometimes trans- 
lucent, very deliquescent. It is soluble in two parts of water, and 
also in alcohol. Dose, grs. v — 3], and is preferably administered in 
milk. TJiis should not be confounded vnth chlorinated lime. (Other 
salts of calcium are included under phosphates, hypo-phosphites, sul- 
phides, and bromides.) 

Antagonists and Incompatibles, and Synergists, the 6ame as 
for potassium. 

Physiological Effects of Calcium Salts. — The important po- 
sition of phosphate of lime in the organism has been already set forth 
under the appropriate head. It is only necessary to state in this con- 
nection that the lime salts are antacid, or alkaline, and as such they 
neutralize the acid of the gastric juice. They act locally as sedatives 
to the mucous membrane. Some of them have a local action merely, 
but the chloride is very diffusible, and the carbonate feebly so. En- 
tering the blood in small quantity, they promote constructive meta- 
morphosis ; but the habitual use of large quantities hastens waste, or 
the retrograde metamorphosis of the tissues. 

Administered in the ordinary way, however, the lime-salts furnish 
materials needed by the organism in its growth. The carbonate of 
lime is taken up in limited quantity by the stomach-juices, and reen- 
forces the same constituent in the blood. The chloride of lime has a 
different office in the economy. It acts in a similar manner to the 
other chlorides, and has close relationship to the iodides. Clinical 
experience has shown that it possesses the ill-defined property known 
as alterative, removes certain toxic or morbific materials, and secures 
their excretion by the organs of elimination. The recent studies of 
the therapeutical actions of chloride of calcium have shown it to pos- 
sess the remarkable property of an antagonist or antidote to the stru- 
mous constitution. No mere physiological investigation could have 
demonstrated this power ; it is an empirical fact which we cannot 
explain as yet by physiological methods. It has been shown, how- 
ever, that under its use enlarged and cheesy lymphatics gradually 



ALKALIES. 189 

resume their normal condition, tubercular deposits undergo a process 
of calcification, and ulcerating cavities discharge their contents and 
cicatrise. It cannot, of course, be asserted that such surprising 
changes frequently occur, but, that they do sometimes take place, 
clinical experience has proved. From this point of view, then, chlo- 
ride of calcium assumes a high degree of importance. 

Therapy of the Calcium Salts. — No remedy is more frequently 
prescribed for vomiting than lime-water. It is given very often with 
milk, one-half, one-fourth, as may be, and the combination is effective 
in arresting vomiting due to acute troubles of the abdominal organs, 
and also useful in vomiting of cerebral and reflex origin. When the 
milk-cure is prescribed, lime-water is frequently added to enhance the 
digestibility of the milk. Carbonate of lime is a useful restorative 
and antacid in the acid indigestion, and in the diarrhoea of strumous 
children. By Dr. Warburton Begbie and by Dr. Coghill the chloride 
of calcium is strongly urged, as the most efficient remedy in the feeble 
digestion and disordered secretions of strumous children. The latter 
especially commends the use of the chloride in " children when the 
sleep becomes restless and troubled, the breath fetid, the tongue foul 
and coated, the tonsils enlarged, the evacuations irregular and offen- 
sive, with deficient secretion of bile." In the colliquative diarrhoea 
of the strumous, it is said to be curative, even when accompanied by 
enlargement of the mesenteric glands. According to the published 
observations of Begbie, Coghill, and Bell, we possess no agent so val- 
uable in the wasting diseases of children of strumous origin, in glan- 
dular enlargements, etc. The testimony which has been lately pub- 
lished in respect to the curative power of chloride of calcium in 
consumption is certainly very striking, and especially in those cases 
succeeding to glandular enlargements heretofore so little amenable 
to treatment. According to Rodolfe, chloride of calcium cures chorea 
speedily. 

Lithium. — Lithium. 

Lithii Carbonas. — Carbonate of lithium. A white powder, spar- 
ingly soluble in water (1 in 100), and having a feeble alkaline reaction. 
Dose, grs. ij — grs. x. 

Lithii Citras. — Citrate of lithium. A white powder, deliquescent 
and soluble in twenty-five parts of water. 

Lithii Salicylas. — Salicylate of lithium. Dose, gr. v — 3j. 

Lithii JBenzoas. — Benzoate of lithium. Dose, gr. ij — gr. xv. 

Antagonists and Incompatibles, and Synergists, are the same 
as for the other alkalies. 

Physiological Actions of the Lithium Salts. — These remedies 
have strong alkaline and basic properties, and act on the organism of 
man in the same manner as the other members of the group. The 



190 AGENTS INCREASING WASTE. 

compound of uric acid and lithium is readily soluble, differing in this 
respect from the urate of soda. It is said that the lithium salts alka- 
linize the urine more decidedly than even the potash salts. 

Therapy op the Lithium Salts. — Garrod first introduced these 
remedies into medical practice for the treatment of rheumatism. It is 
doubtful whether they possess any special virtues. Recently the com- 
pound of lithium and salicylic acid has been brought forward as a 
more effective remedy in the rheumatic diseases. The subacute and 
chronic cases, and the so-called rheumatic gout, are the forms of the 
disease in which the lithium salts are most serviceable. In the so- 
called uric-acid diathesis, in renal calculi, composed of uric acid, and 
in irritable bladder from an excess of acid in the urine, the salts of 
lithium are useful. In the case of a renal calculus a very protracted 
use of a well-diluted solution is necessary. 

External Applications of the Alkalies. — A solution of com- 
mon soda (impure bicarbonate) freely applied will often remove the 
fetid sweat of the feet, and the odorous emanations which in some 
subjects escape from the axillary glands. Acne occurring in persons 
with a greasy skin, and prominent and black sebaceous follicles, may 
sometimes be cured by alkaline lotions. R . Liq. potassae, 3 j ; aquae 
rosae, 3 iv. M. Sig. Apply with a soft sponge twice a day. For 
acute eczema where there is much serous discharge, no applications are 
more efficient than solutions of the alkalies. R. Sodii carbonat., 3 ss ; 
aquae, Oj. M. Sig. The eruption to be covered with lint soaked in 
this solution. Stronger solutions can be used in old cases where the 
skin is much thickened. As alkalies, by absorbing the moisture and 
combining with the fat of the sebaceous matter, make the skin dry 
and harsh, it is useful to apply some form of oil after these alkaline 
applications, certainly after the stronger solutions. Mutton-suet is one 
of the best fats for this purpose. 

In prurigo great relief is often obtained by an alkaline warm bath 
at bedtime. A solution of carbonate of potassium ( 3 iij — 1 iv) is 
recommended by Trousseau as a remedy for that obstinate affection — 
pruritus vidvce. In freckles, sunburn, and tan, the following lotion is 
useful: R. Potassii carbonat., 3 iij ; 6odii chloridi, 3ij; aquae rosae, 
3 viij ; aquae aurantii flor., 3 ij. M. Sig. Lotion. 

To cleanse the scalp from dandruff (pityriasis), there is no more 
suitable application than a saturated solution of borate of soda. Pow- 
dered borax, mixed with sugar, is a domestic remedy for aphtha? of 
children ; it is simply placed on the tongue. A saturated solution of 
borax in rose-water is a useful application to remove freckles, and to 
allay pruritus vagina?. 

A solution of permanganate of potassa (gr. 3 — 3 j) is an elegant 
toilet remedy for correcting fetor of the breath. In idcerous diseases 
of the buccal cavity it is used to destroy foul odors, and to improve the 



ALKALIES. 191 

condition of the sloughing surface. In ill-conditioned wounds gener- 
ally solutions of this salt, in various strengths, arc employed with a 
view to change the action, but little more is accomplished than tempo- 
rary destruction of odors. There are many other agents, much less 
expensive and more powerful, which can be used for these purposes. 

The so-called ingrowing toe-nail may be cured by the application 
to the irritable granulation, at the margin of the nail, of a solution of 
liquor potassae ( 3 ij — 3 j). This solution is to be applied on cotton- 
wool, to the margin of the nail and to the ulcerated surface of the 
toe, until the nail is so far softened that it can be cut away without 
pain. 

Unhealthy and sloughing ideers may be destroyed by potassa fusa, 
and a healthy granulating surface be left. No more efficient escharotic 
can be used in hosjiital gangrene. As it penetrates deeply and widely, 
great care must be used to limit its application to the affected parts, 
and, as soon as the destruction is sufficient, to check the further exten- 
sion of the caustic by washing with a dilute acid. Vienna paste — which 
is a mixture of equal parts of potassa and lime made into a paste with 
alcohol — is milder in operation, and therefore usually preferred. Caus- 
tic potash was formerly much employed to make issues, to open ab- 
scesses and carbuncles, but these applications are now quite obsolete. 
Induration of the cervix uteri and chronic metritis (hyperplasia of the 
connective tissue) are, it is said (Dr. Bennet), very effectively treated 
by application of caustic potassa and potassa cum calce ; but such pow- 
erful means must be used with great caution, if at all. In carcinoma, 
when the disease is limited to the neck of the uterus and not too far 
advanced, caustic potassa may be used with advantage to destroy the 
diseased surface. This caustic is quite as efficient as any, probably, 
for the escharotic treatment of cancer when this method of treatment 
is employed. 

A solution of the bichromate of potassium (gr. j — grs. x — 3 iv) is 
an excellent local application in the treatment of the catarrhal state 
of the nasal, buccal, or vaginal mucous membrane. A saturated solu- 
tion of this salt may be used as a caustic in place of chromic acid. 

Carbonate of soda in saturated solution has been used lately with 
signal success in the treatment of burns: it allays the pain, checks 
suppuration, and favors healing (McClellan, Pring, etc.). Cloths 
dipped in a saturated solution, and covered with oiled silk, are kept 
on the part, the solution being renewed as rapidly as may be neces- 
sary. Dr. Duckworth reports that toothache may be quickly allayed 
by holding a solution of carbonate of s^da in the mouth. Recently 
chlorate of potash has been used with success in the treatment of epi- 
thelioma. This practice was first suggested by Vidal in the treatment 
of chancroid, and has since been successfully employed in the treat- 
ment of obstinate ulcers, epithelioma and cancer (Fereol, Leveque). In 



192 AGENTS INCREASING WASTE. 

the simpler cases a saturated solution may be applied, but in epithe- 
lioma and caucer the powdered chlorate is thickly placed over the 
sore. It is said to allay pain, remove fetor, and promote cicatrization 
when so applied. The internal use of the salt is recommended in 
conjunction with the topical application in cancer, epithelioma, and 
lupus. 

Authorities referred to : 

Basham, Dr. W. R. The Practitioner, vol. v., p. 257. 

Begbie, Dr. J. Warburton. The Edinburgh Medical Journal, July, 1870, p. 46. 

Bell, Dr. Robert. The Lancet, August, 1877, p. 275. 

Binz, Dr. C. Archiv fur experiment. Pathologie und Pharmacologic, vol. x., p. 153. 
Ueber Reduction des chlorsauren Kalis. 

Buchheim, Prof. Dr. R. Archiv fur experiment. PatJwl. und Pharmacol., Band iii., 
p. 252. Ueber die Wirkung der Kaliumsalze. 

Coghill, Dr. J. G. Sinclair. Tlie Practitioner, vol. xix., p. 247. Therapeutic Notes 
on the Chloride of Calcium. 

Duckworth, Dr. Dyce. The Practitioner, April, 1875, p. 250. 

Fuller, Dr. H. W. The Practitioner, vol. ii., p. 129. The Alkaline Method in the 
Treatment of Rheumatism. 

Guttmann, Dr. P. Virchow's Archiv, Band xxxv., p. 450. Wirkung der Kali und 
Natronsalze. 

Hummel, Meinrad. Allg. Wiener med. Zeit., 23-26,1878. Ueber das Kalium Chloricum. 

Isambert, Dr. Gaz. Med. de Paris, 1874, Nos. 17, 35, 41, and 43. Nouvelles expe- 
riences sur Paction physiologique, toxique et therapeulique du chlorate de polasse. 

Kohler, Prop. Dr. H. Centralblatt f. d. med. Wiss., 1877, No. 38, p. 673. Zur 
Wirkung der Kaliumsalze auf Warmbluter. 

Laborbe, Dr. J. V. Bull. Gen. de Therap., 1874, p. 247, 319, and 354. Etude com- 
parative de Paction physiologique des chlorates de potasse et de soda, etc. 

Marchand, Dr. F. Virchow's Archiv, Band lxxvii., p. 455. Ueber die Intoxication 
durch Chlorsaure Salze. 

McClellan, Dr. Ely. Louisville Medical Nev:s, 1878. On Relief of Burns by a Satu- 
rated Solution of the Carbonate of Soda. 

Parkes. On the Urine, p. 158! 

Perl, Dr. Leopold. Virchow's Archiv, vol. Ixxiv, p. 54. Ueber die Resorption der 
Kalksalze. 

Podcopaetv, Dr. Virchow's Archiv, Band xxxiii., p. 505. Vergleichende Untersu- 
chungen uber die Wirkung des Chlorkalium und Chlornalrium auf den thierchen Organ- 
mnus. 

Pring, Dr. E. J. Philadelphia Medical Times, March 16, 1878, p. 273. Note on the 
Use of Bicarbonate of Soda in Burns. 

Rabuteau, Dr. Gazette Hebdom., xliii., 1868, p. 617. Recherches sur P elimination 
el sur propri'etes osmotiques du sulfate de sodium. 

Ralfe, Dr. C. Lancet, November, 1878, p. 651. Observations in Urinary Pathology 
and Therapeutics. 

Ringer and Murrell. Journal of Physiology, vol. xii., p. 5. Influence of the Chloride 
of Potassium on the Nervous System of Frogs. 

Schonlein, K. Arch. f. d. ges. Physiol., vol. xviii., p. 26. Versuche Uber einige 
physiologische Wirkungen des Natriumcarbonats. 

Valentin, Dr. Zeit. fur Biol., vol. xiv., p. 320. Die Gifticirkungen welche Salzbader 
auf Frbsche ansubcr. Virchow u. Hirsch. Jahresbericht. 



ALKALINE SPRINGS. 198 

ALKALINE MINERAL SPRINGS. 
1. Nortii America. 

Bladoil Springs, Choctaw Count}', Alabama. A rolling, pine-woods 
region. 

They contain carbonate of soda, carbonate of magnesia, carbonate 
of iron, carbonate of lime, sulphate of lime, carbonic-acid gas, sul- 
phuretted hydrogen (traces), and chlorine. 

Congress Springs, Santa Clara County, California. In the Coast Range 
of mountains. 

They contain carbonate of soda (15.418 grains to the pint?), carbo- 
nate of iron, carbonate of lime, chloride of sodium (14.894 grains to the 
pint), sulphate of soda, etc. They are highly charged with carbonic- 
acid gas. 

California Seltzer Springs, Mendocino County, California. 

They contain carbonate of soda, carbonate of magnesia, carbonate 
of lime, carbonate of iron (a trace), and chloride of sodium. They are 
also highly charged with carbonic-acid gas. 

Perry Springs, Pike County, Illinois. 

They contain carbonate of potassa, carbonate of magnesia, carbonate 
of iron, carbonate of lime, sulphate of soda, silicates of soda and potassa. 
Temperature of the water is from 48° to 50° Fahr. 

St. Louis Spring, Gratiot County, Michigan. 

This water contains carbonate of soda (7.684 grains to the pint), car- 
bonate of magnesia, carbonate of iron, carbonate of lime (5.019 grains 
to a pint), sulphate of lime (6.925 grains to a pint), silicate of lime, and 
silica. This is one of the so-called " magnetic springs " — the magnetic 
property being due not to the water, but produced by the magnetization 
with terrestrial currents of the vertical iron tube through which the 
water flows. It is unfortunate that this part of the peninsula of Michi- 
gan, in which the numerous alkaline and saline springs abound, is very 
decidedly malarious. 

Rockbridge Baths, Rockbridge County, Virginia. A mountainous 
region. 

They contain magnesia and iron, with a small quantity of iodine. 
Temperature, 74° Fahr. Used chiefly in the form of baths. 

Capon Springs, Hampshire County, West Virginia. 

This water contains carbonate of soda, carbonate of magnesia, and 
traces of iodine and bromine. The temperature of the water is 66° 
Fahr. These springs are situated in a romantic mountain-region. 

2. European. 
Vichy, Central France. 

There are several springs — Grande Grille, Puits Carre, Hopital, 
Celestins, De Mesdames, and others. The waters contain carbonates 
of soda, of potassa, magnesia, and lime, sulphate of soda and chloride of 
14 



194 AGENTS INCREASING WASTE. 

soda, phosphate of soda, arseniate of soda (a trace), carbonates of strontia 
and iron. The gas, which is abundant, is carbonic acid. 

In the Vichy region there are numerous alkaline springs having 
similar properties. The temperature of the waters varies from 58° Fahr. 
(Celestins) to 178° Fahr. (Chaudes Aigues). 

Mont Dore, valley of the Dordogne, France. 

The waters are weak alkaline, and have a temperature from 90° to 
104° Fahr. Their principal constituent is carbonate of soda. These 
springs lie among the volcanic mountains of Auvergne, at an elevation 
of 3,300 feet. 

Vals, Ardeche, France. 

The waters of these cold springs are remarkable for the quantity of 
carbonate of soda which they contain. They are abundantly charged 
with carbonic-acid gas. 

Ems, on the Lahn, Germany. 

These waters contain, according to the analysis of Fresenius, 14 tc 
15 parts of bicarbonate of soda, 7 parts of chloride of sodium, and 1.7 
part each of bicarbonate of lime and bicarbonate of magnesia, with 
sulphates of soda and potash, and bicarbonates of iron, manganese, 
baryta, strontia, and alumina in small quantity, to the pint. The gas is 
carbonic acid, from 6 to 8 cubic inches to the pint. 

Neuenahr, valley of the Ahr, between Bonn and. Coblentz, Germany. 

The waters of these springs have a composition similar to those of 
Ems, but have about half as much soda and very little salt. 

Salzbruiin, Upper Silesia, near Freiburg, Germany. 

These waters are very rich in carbonate of soda. 

Gleichenberg, near Gratz, Styria, Austria. 

These springs are much more alkaline than Ems. The waters con- 
tain from 20 to 27 parts of carbonate of sodium, 19.5 of chloride of so- 
dium, and 7.8 of carbonate of magnesium. The water is highly charged 
with carbonic-acid gas. 

Therapeutical Uses of the Alkaline Mineral Waters. — As we have 
seen that alkalies taken before meals increase the production of acid 
gastric juice, the alkaline mineral waters are serviceable in atonic dys- 
pepsia. They are especially useful in catarrh of the duodenum and 
of the bile-ducts, and in the jaundice dependent on this state cf the 
mucous membrane. In incipient cirrhosis, in congestion of the portal 
circulation, and in haemorrhoids due to the hepatic obstruction, they 
render important service. Obesity, which is frequently diminished by 
a course of alkalies, is better treated by alkaline waters, for at the 
springs these patients can be induced, more easily, to conform to the 
plan of exercise and diet necessary in these cases. 

The alkaline springs have long had a deserved reputation for the 
cure of gout and rheumatism. With the internal use of the waters 
should be conjoined baths, douches, etc. Gout and rheumatic affections 
of internal organs are equally amenable to the same treatment. 



SALINE srRI^r.S 105 

These alkaline waters, long used, are especially serviceable in the 
Bo-called Uthic-acid diathesis. There is little doubt that the continuous 
use of alkaline waters for a long period will cause the solution of uric- 
acid renal calculi. For this purpose those alkaline waters rich in 
potassa are preferable. 

When diabetes is hepatic in origin, and occurring in obese subjects, 
the alkaline mineral waters are extremely useful. A suitable diet 
should be enjoined. 

The following domestic mineral waters may be advised in the above 
states : Bladon Springs ; the California Seltzer ; Perry Springs ; St. 
Louis Spring ; but especially, Capon and the alkaline Springs of Wis- 
consin. 

Of the foreign, the most important are Vichy, which is imported at 
a moderate price, Mont Dore, Vals, Ems, Salzbrunn, and Gleichenberg. 

The psychical influences of change of scene, associations, and cli- 
mate, are largely concerned in the results of treatment with the waters 
of mineral springs. 

SALINE MINERAL WATERS. 
1. North American. 

St. Catharine's Wells, St. Catharine's, Ontario, Canada. 

These contain chloride of sodium (217 to 275 grains to the pint), 
chlorides of potassium, magnesium, calcium (108 to 127 grains to the 
pint), sulphate of lime, and iodide and bromide of magnesium. A con- 
centrated water prepared by evaporation is used, properly diluted by 
patients at a distance for internal diseases, and at the wells, externally. 

These waters are diluted with ordinary water to three-fourths or 
seven-eighths, before they are drunk. They are chiefly used as warm 
baths. The diseases in which they have been found most beneficial 
are chronic gout, rheumatic gout, chronic rheumatism, and gouty and 
rheumatic diseases, strumous diseases, engorgement of the />efouc vis- 
cera, chronic metritis, uterine fibroids, ha-morrhoids, etc. 

Spring Lake Well, Ottawa County, Michigan. 

The water of this spring contains chloride of sodium (50.691 grains 
to the pint), chloride of calcium (14.177 grains to the pint), chloride of 
magnesium, carbonates of soda, manganese, and iron, in small quantity, 
sulphate of soda (5.837 grains to the pint), bromide of magnesium, and 
a trace of lithia. 

These waters are applicable to the treatment of gout, rheumatism, 
strumous diseases, etc. The waters are drunk and used as warm baths. 

Saratoga Springs, Saratoga, New York. 

In general terms, these waters contain chloride of sodium, the alka- 
line carbonates, and are highly charged with carbonic-acid gas. The 
springs are numerous, and differ somewhat in composition. I subjoin a 
tabular statement of the analyses of the different waters, from the ex- 
cellent work of Dr. Walton : 



196 



AGENTS INCREASING WASTE. 



One pint contains— 


1 

j5 ,. S 

If 5 

■=> . * 

gSrj 

o 


sis 

o 2 d 


o O 

-fa 


■a 

a 
■ ** 

J: ^ 

P. . 
S fe 

w u 

1 


ft 

| g 


6 -a 
=5 ° 

*ri 


£ a 

sS 

•g fa 
2 


1 

So *» 

WO . 

•a rj 


SOTJDS. 


Grains. 
3.024 
4.069 
0.135 

11.443 
0.154 
trace. 
0.050 
1.122 

48.766 
0.201 


Grains. 
0.934 

9.019 
0.031 

12.449 
0.374 
trace. 
0.095 
1.006 

50.055 
0.111 


Grains. 

0.372 
13.072 

0.101 
14.815 

trace. 
0.178 
1.199 
63.746 
trace. 


Grains. 
0.7S2 
3.182 
0.079 
9.520 
0.163 
trace. 
0.008 
0.536 

63.328 
0.346 


Grains. 
1.336 
8.461 
0.698 
8.500 

33.375 


Grains. 
0.327 
5.650 
0.233 

10.432 
0.744 
trace. 
0.090 
0.958 

57.439 
0.254 


Grains. 
0.405 
5.899 
0.065 
8.084 
0.380 
0.001 
0.094 
1.078 

17.734 


Graius. 
2.552 




2.988 
0.155 




7 804 




0.071 




trace. 
0.167 




16.786 




069 


























trace. 


0.002 


0.001 


0.003 




0.001 


0.002 










0.011 
0.091 
trace, 
trace. 
0.153 


0.017 
1.069 
trace, 
trace, 
trace. 


0.025 
0.192 
trace. 

0.016 


0.001 
0.033 
trace, 
trace. 
0.052 


0.320 


0.009 
0.123 
trace, 
trace. 
0.041 


0.006 
0.106 
trace, 
trace. 
0.012 


004 




0.079 












0.047 


























0.2S3 
trace. 


0.105 
trace. 


0.157 
trace. 


0.1S2 
trace. 


0.256 


0.394 
trace. 


0.398 
trace. 


0.320 










Gas. 


69.502 

Cubic in. 

51 
(1S66.) 


75.267 

Cubic in. 

49 
(1871.) 


93.874 

Cubic in. 
47 


78.215 

Cubic in. 

43 
(1872.) 


47.946 

Cubic in. 
34 


76.745 

Cubic in. 

41 


33 764 

Cubic in. 
30 


31.042 

Cubic in. 
40 







One pint contain? — 


£> s fa 

So 

& 


•1 ° 

S fc fa 

S d 

I 

Grains. 
1.097 
4.586 
0.110 

10.795 
0.124 

trace. 
0.010 
1.212 

49.795 
0.675 


a 

p. . 


ft 

S 

I g" 


ft 

1 s" 


ft 

E g 


S 

a 

|r: 

<5 go 

o 

£ 


Solids. 


Grains. 
6.175 

10.322 
0.089 

14.793 
0.549 
0.041 
0.206 
8.079 

70.260 

trace. 


Grains. 
1.107 
2.618 

7.324 
0.016 


Grains. 
0.625 
3.667 
0.375 
5.165 


Giains. 
1.875 
4.042 
0.402 
9.625 


Grains. 
4.231 
4.8S3 
0.573 

12.249 


Grains. 

1.212 




5.568 




0.135 


Carbonate of lime 


8.845 




0.839 










trace. 












0.074 


Chloride of potassium 


0.686 

8.699 








1.040 


20.852 


46.330 


37.332 


42.058 


Sulphate of potassa 


0.269 








0.165 














0.268 






Phosphate of soda 


trace. 


trace. 


trace, 
trace. 






0.001 














0.031 
0.276 
trace, 
trace, 
trace. 


0.015 
071 
trace, 
trace, 
trace. 


0.5S3 
0.196 


0.529 


0.449 


0.008' 


Bromide of sodium 


0.051 








trace. 
















> 0.219 


0.029 






0.038 




0.S75 
0.500 




















Silica 


0.013 
trace. 


0.160 
trace. 


0.339 


0.067 


3 0.125 


0.401 


















Total 


105.334 
Cubic in. 

57 
(1870.1 


68.650 

Cubic in. 

50 


21.008 

Cubic in. 


31.827 

Cubic in. 

29 


64.843 

Cubic in. 
31 


59.897 

Cubic In. 
40 


60.0S9 


Gas. 


Cubic in. 
89 




(1870) 



1 Alumina and seaqtioxlde cf iron. 



* Silica and alumina. 



SALINE SPRINGS. 197 

Those waters are useful in plethora of the abdominal viscera, in 
obesity, in habitual constipatio?i due to deficient secretion, in plethora 
of the pelvic viscera, haemorrhoids, etc. The waters of the Pavilion 
and Geyser Springs, owing to the quantity of lithia which they contain, 
are especially serviceable in chronic gout, chronic rheumatism, rheu- 
matic gout, and affections dependent on these diatheses. The Colum- 
bian, Pavilion, Eureka, and Excelsior, containing a considerable pro- 
portion of iron, are more especially adapted to cases of the above-men- 
tioned disorders, in which amvmia exists, but they must be drunk with 
caution by the plethoric. 

Ballston Spa, Ballston, Saratoga County, New York. 

These waters are similar in composition to the waters of the Sara- 
toga Springs, but they are richer in mineral constituents. The propor- 
tion of chloride of sodium ranges from 53.12 grains to 93.753 grains in 
a pint. The Lithian "Well contains 13.378 grains of carbonate of mag- 
nesia, 20.675 grains of carbonate of lime, 4 grains of chloride of potas- 
sium, to the pint, besides carbonates of soda, iron, lithia, strontia, 
baryta, phosphate of soda, sulphates of potassa and soda, iodide and 
bromide of sodium. Carbonic-acid gas from 30 to 57 cubic inches. 

These waters are applicable to the treatment of the same cases as 
the Saratoga waters. 

2. European. 

Cheltenham, Gloucestershire, England. 

These spas are saline aperient, ioduretted saline, ioduretted-magne- 
sian saline, and the waters contain a good deal of carbonic acid. The 
season is from July to October. These waters are chiefly serviceable 
in dyspepsia, hepatic affections, and constipation. Some of the springs 
at Cheltenham contain iron, and the water of these is employed in chlo- 
rosis and anosmia. 

Leamington, Warwickshire, England. 

These waters contain chlorides of calcium and sodium, and sulphate 
of soda, with carbonic acid. They are much prescribed in dyspepsia, 
acidity, and hepatic troubles, constipation, etc. 

Adelheidsquelle, Heilbrunn, Bavaria. Altitude 2,000'. Tempera- 
ture of spring, 50° Fahr. Season, May to September. 

This valuable water contains chloride of sodium, carbonate of so- 
dium, iodide and bromide of sodium, etc. ; carbonic acid, 13.18 cubic 
inches. It is highly prized in strumous diseases, rheumatism, gout, 
affections of the skin, and pelvic troubles of females {chronic metritis, 
fibroids, etc.). 

Baden-Baden. Altitude, 616'. Mean annual temperature, 48° Fahr. 
Season, May to October. 

According to Bunsen's analysis, these waters contain chloride of 
sodium, bicarbonate of lime, magnesia, and iron, sulphates of lime and 



198 AGENTS INCREASING WASTE. 

potash, arseniate of iron (a trace), chloride of potassium, bromide of 
sodium (traces), etc. ; carbonic-acid gas. The Meurquelle contains 2.3694 
grains of chloride of lithium in 20 ounces. 

Carlsbad, Bohemia. Altitude, 1,200'. Season, June to September. 

These waters contain sulphate of soda, carbouate of soda, chloride 
of sodium, sulphate of potash, carbonate of lime, etc. Marktbrunnen 
contains, besides these ingredients, a small quantity of carbonates of 
lithia, strontia, and manganese, and iodide and bromide of sodium ; the 
gas is carbonic acid. 

The Carlsbad water is highly prized in affections of the liver and 
portal system, uterine diseases, gout, rheumatism, and diabetes. 

Friedrichshall, Saxe-Meiningen, Germany. Bitter water. 

According to Liebig, this Avater contains sulphate of soda 46.51 
grains, sulphate of magnesia 39.55, chloride of sodium 61.10, chloride 
of magnesium 30.25, sulphates of potash 1.52, and of lime 10.34 grains. 
Carbonic-acid gas, 5.32 cubic inches. 

This is aperient, and is used in diseases of the stomach, liver, intes- 
tines, and kidneys. It is imported in quart-bottles, and is much pre- 
scribed as a laxative in habitual constipation, in hepatic troubles, pleth- 
ora of pelvic organs, etc. 

Homburg, Central German}^. Altitude 600'. Open all the year, but 
the season is from May to September. Temperature, 50° to 53° Fahr. 

According to the analysis of Liebig and Hofmann, these waters con- 
tain chlorides of sodium (79 to 104 grains), potassium, magnesium, and 
calcium, carbonates of lime, magnesia and iron, and sulphates of soda 
and lime. Free carbonic acid, 48 cubic inches. 

In therapeutical action they are laxative, and are prescribed in 
habitual constipation, dyspepsia, abdominal and pelvic plethora, obes- 
ity, hypochondriasis, hysteria, etc. 

Kissingen, Bavaria. Altitude, 800'. Temperature of springs, 50° 
Fahr. The season is from May to September. 

Liebig's analysis has shown that these waters contain chlorides of 
sodium (17.52 to 44.71 grains), potassium, lithium, and magnesium, 
sulphates of lime and magnesia, carbonates of lime and iron, bromide 
and iodide of sodium, etc. They are highly charged with carbonic acid. 

Kissingen waters are laxative, and are used in dyspepsia, hepatic 
obstructions, albuminuria, diabetes, etc. 

Kreutznacb., Rhenish Prussia. Altitude, 285'. Season is from June 
to September. 

This powerfully-alterative water contains chloride of sodium (72 to 
108 grains to the pint), chloride of calcium (13 to 22 grains to the pint), 
chlorides of magnesium, potassium and lithium, carbonate of lime and 
iron, bromide and iodide of magnesium. 

The mother-liquor of Kreutznacb contains 2,484 grains of solid mat- 
ter in sixteen ounces. 



AMMONIUM. 199 

These waters are extremely serviceable in constitutional syphilis, 
strumous diseases, affections of the skin, rheumatism, gout, engorge- 
ment of the abdominal and pelvic organs, hepatic diseases, etc. 

Marienbad, Bohemia. Altitude, 1,900'. Season is from May to 
September. 

The principal constituents of this water are sulphate of soda, bi- 
carbonate of soda, chloride of sodium, bicarbonate of lime, bicarbonate 
of magnesia, and salts of lithia, strontia, iron, and manganese, in small 
quantity ; carbonic-acid gas. 

Laxative, and used in hepatic disorders, dyspepsia, habitual con- 
stipation, gravel, gout, etc. 

Reichenhall, Upper Bavaria. Altitude, 1,407'. Mean temperature 
of spring, 50° Fahr. ; of summer, G4° Fahr. ; of autumn, 54° Fahr. Sea- 
son, July and August. 

Used only for baths. Inhalations are practised here on a large 
scale. "The compressed-air cure" is also used. Scrofula, phthisis, 
and affections of the throat, are chiefly treated. 

The waters are rich in chlorides of sodium and magnesia, and sul- 
phates of soda and lime. 

Seidlitz, Bohemia. 

The chief constituents are sulphate of magnesia, sulphate of soda, 
carbonate of lime, sulphate of lime, sulphate of potash, and chloride of 
magnesium. 

Saline purgative. 

Selters, Nassau. 

Kastner's analysis has shown that this water contains bicarbonate 
of soda, chloride of sodium, bicarbonates of lime and magnesia, iron and 
manganese, phosphates of lime, alumina and soda, bromide of sodium, 
etc. Highly charged with carbonic acid. 

Laxative and alterative. 

Authorities referred to : 

Braun, Dr. Julius. Si/slematisches Lehrbuch der Balneolherapie, Berlin, lS'ZS. 

Macpherson, Dr. John. The Baths and Wells of Europe, second edition, London, 
Macmillan & Co., 1873. 

Moorman, Dr. J. J. Mineral Springs of North America, Philadelphia, J. B. Lippiu- 
cott & Co., 1873. 

Valentiner, Dr. Th. Handbuch der allgemeinen und speciellen Balneolherapie, Be»- 
lin, 1873. 

Walton, Dr. Geo. E. Mineral Springs of the United States and Canada. 

AMMONIUM AND ITS PREPARATIONS. 

Preparations. — Ammonii Benzoas. Benzoate of ammonium. Ben- 
zoic acid and ammonia. In minute, white, shining, thin, four-sided, lami- 
nar crystals ; bitter, saline, and somewhat balsamic in taste ; soluble in 
water (1 in 5), and in rectified spirit (1 in 12). Dose, gr. v — gr. xv. 



200 AGENTS INCREASING WASTE. 

Ammonii Garbonas. — Carbonate of ammonium. In white, trans- 
lucent masses, with a pungent and ammoniacal odor, soluble in water 
(1 in 4). Dose, gr. v — gr. x. 

Ammonii Chloridum Puriflcatum. — Purified chloride of ammonium. 
Sal-ammoniac. In a snow-white, crystalline powder, soluble in two and 
a half parts of cold water, and sparingly soluble in alcohol (1 in 55). 
Dose, gr. j— 3j. 

Ammonii Valerianas. — Valerianate of ammonium. A white salt in 
quadrangular plates, having the odor of valerianic acid, and a sharp, 
sweetish taste, and is very soluble in water and in alcohol. Dose, 
gr. 1 — gr. v. 

Ammonii Phosphas. — Phosphate of ammonia. In colorless, trans- 
parent prisms, soluble in water (1 in 2), but insoluble in alcohol. Dose, 
gr. v— 3j. 

Aqua Ammonice. — Water, or solution, of ammonia. Ammonia-gas 
dissolved in water. A transparent, colorless liquid, having a very pun- 
gent odor. Dose, 3 j, contains 5.2 grains of ammonia. 

Liquor Ammonii Acetatis. — Solution of acetate of ammonium. 
Spirit of mindererus. Dose, 3 j — 1 j. 

Spiritus Ammonioe. — Spirit of ammonia. A solution of ammoniacal 
gas in alcohol. Dose, m. x — 3 j. 

Spiritus Ammonice Aromaticus. — Aromatic spirit of ammonia. 
Solution of carbonate of ammonia, oils of lemon, nutmeg, and lavender, 
in alcohol and water. Dose, 3 ss — 3 ij. 

Linimentum Ammonice. — Liniment of ammonia. Olive-oil and 
aqua ammonise ( % j — § ij). 

JRaspaiVs Eau S'edatif. — Liquor ammonise, two ounces ; chloride of 
6odium, two ounces ; camphorated spirits of wine, three drachms ; 
water, thirty-two ounces. 

Antagonists and Incompattbles. — The vegetable and mineral 
acids, acidulous salts, earthy salts, and lime-water, are incompatible 
with the carbonate. In addition to the acids, potash, soda and their 
carbonates, salts of lead, silver, and metallic sulphates, are incompatible 
with the solution of the acetate. The persalts of iron, acids, and liquor 
potassse, are incompatible with the benzoate. Alkalies, alkaline earths 
and their carbonates, and lead and silver salts, are incompatible with 
the muriate. In the treatment of poisoning by ammonia or its car- 
bonate, the vegetable acids should be used to neutralize the poison, and 
its irritant action on the mucous membrane should be limited as much 
as possible by the administration of oil and demulcents. 

Therapeutically, ammonia is antagonized by veratrum viride, aconite, 
digitalis, cold, and other cardiac sedatives. 

Synergists. — The action of ammonia is favored by heat, opium, 
iodine, by the antispasmodics, as valerian, asafcetida, etc., by the difiu* 
sible and aromatic stimulants, as alcohol, ether, etc. The therapeutical 



AMMONIUM. 201 

activity of the iodides and bromides is promoted by combination with 
Carbonate of ammonia. 

Physiological Actiox. — Ammoniacal gas, brought in contact with 
a mucous surface, irritates it ; applied to the eye, it reddens the con- 
junctiva, and causes lachrymatiou ; applied to the nares, it reddens the 
mucous membrane, produces a sense of heat and burning, and increases 
the secretion of mucus. Inhaled, an overpowering sense of suffocation 
is experienced, and the glottis spasmodically closes. Prolonged contact 
with the air-passages excites violent inflammation. When solution 
of ammonia is swallowed, an active and destructive inflammation of the 
mucous membrane is set up ; the lips, tongue, soft palate, and tonsils, 
are swollen, red, and glazed ; the epiglottis, and especially the arytseno- 
epiglottidean folds, becomes cedematous, and sudden death may ensue 
.torn oedema of the glottis. Inflammation of the oesophagus, and of a 
limited portion of the stomach, will also follow the introduction of any 
portion of the irritant. Narrowing (stenosis) of the pyloric orifice has 
been noted, in one case, as an after-result of the inflammation set up in 
this part. In the stomach, ammonia and its carbonate must quickly 
combine with the acid, and probably enter the blood in such combina- 
tion. Increased action of the heart is produced by its administration by 
the stomach, but much more decidedly when it is thrown directly into 
a vein. After the intra-venous injection of ammonia, the blood-pressure 
at first rises, then falls below the normal. Resulting, doubtless, from 
the increased action of the heart, and the more rapid circulation of the 
blood, a subjective sensation of warmth throughout the body is expe- 
rienced, the face becomes flushed, the eyes are more brilliant, and the 
mental operations increase in activity. Little is known of the behavior 
of ammonia in the blood, which in the normal state contains this gas. 
Although it is now known that the coagulation of the blood is not 
caused by the escape of ammonia, as supposed at one time by Richard- 
son, yet ammonia helps to maintain the fluidity of the blood, as its 
presence, in sufficient quantity, certainly serves to hold the fibrine in 
solution. 

The long-continued use of ammonia impairs digestion, by neutralizing 
the gastric juice. Increased waste of tissue is also one result of its 
administration, manifested by pallor, emaciation, and feebleness. "When 
introduced into the blood in sufficient quantity, it damages the structure 
of the red blood-globules, and in this way also it affects the nutrition 
of the body, beside the action which it has, in common with the other 
alkalies, of increasing the rate of waste or retrograde metamorphosis. 

The summary of the physiological actions of ammonia, above given, 
pretty fairly represents the movement of these agents as a group ; but 
individual differences undoubtedly exist, which will be pointed out 
when the therapy is considered. 

TnKHAPY. — Ammonia and its carbonate are sometimes used to 



202 AGENTS INCREASING "WASTE. 

diminish acidity of the stomach-juices. Obstinate vomiting, after irri- 
tating substances are removed, and when the vomited matters are acid, 
may be relieved by the use of the carbonate, or better, by an excess of 
carbonate in solution of the acetate. The acidity, gaseous eructations, 
and abdominal distention, which accompany attacks of hysteria in some 
females, may be quickly removed by the aromatic spirit of ammonia. 
JSTervous headache, especially when it is present with the last-mentioned 
group of symptoms, is speedily relieved by the aromatic spirits and the 
carbonate ; but true migraine, although these preparations of ammonia 
may palliate it, is generally more certainly relieved by the bromides. 
Raspail's eau sedatif often gives great comfort in headache, when 
locally applied. 

In gastric and intestinal catarrh, chloride of ammonium is held in 
high repute by our German confreres. It is certainly highly serviceable 
in some hepatic disorders — for example, in catarrh of the bile-ducts and 
in the jaundice arising from this cause. In the first stage of cirrhosis, 
before contraction and induration have occurred, it is also useful. The 
nauseous saline taste of the sal-ammoniac is best covered by fluid ex- 
tract of taraxacum or extract of liquorice. The fluid extract of taraxacum 
is to be preferred as the vehicle in hepatic disorders, because this drug 
has reputed virtues in these cases. When there is deficiency of secre- 
tion of the intestinal juices, constipation, and a coated tongue, with 
scanty and high-colored urine (so-called bilious state), sal-ammoniac is 
one of the remedies which may be used with success. That this drug 
has a selective action on the liver seems probable from the fact that it 
increases the excretion of urea by the kidneys. 

To stimulate the action of the heart when it flags, the ammonia prep- 
arations have an undoubted effect ; hence in adynamic states they are 
frequently used. When employed for this purpose, small doses frequently 
repeated (every half-hour or hour) are necessary, owing to the fact that 
ammonia is quickly eliminated. It is a most common practice to inhale 
ammonia to prevent that depression of the heart's action called faint- 
ing. It should not be forgotten that ammonia, incautiously inhaled, 
may give rise to inflammation of the fauces and glottis. The prepara- 
tions of ammonia (spirits, carbonate, water of) possess a high degree 
of utility when tJirombosis is actually existent, but especially when 
threatened, as in the puerperal state, after free hemorrhage, when the 
circulation is languid from weak heart, a state of hyperinosis being 
present. It is perfectly safe and legitimate under these circumstances 
to practice the intra-venous injection of aqua ammonia, 3 j — 3 ij, diluted 
with an equal measure of water. This practice seems more particularly 
advisable when sudden thrombosis of a large venous trunk ensues — as, for 
example, in the pulmonary artery, after uterine haemorrhage. In sudden 
paralysis of the heart from chloroform narcosis, the bite of venomous 
snakes, etc., this practice has been resorted to, but hitherto, without 



AMMONIUM. 203 

any recognized success. As regards the intra-venous injection of am- 
monia as a remedy for the bite of venomous snakes, Brunton and 
Fayrer have shown that this practice is without value. Ammonia is a 
physiological antagonist to hydrocyanic acid, and is used in poisoning 
by this agent ; it counterbalances the depression, and maintains the 
heart's action, until the effects of the poison are spent. 

Carbonate of ammonia is one of the remedies occasionally success- 
ful in the treatment of delirium tremens. It is indicated, and proves 
most serviceable, when there is present anaemia of the brain, and the 
heart's action is feeble. Half-ounce doses of solution of ammonia ace- 
tate are said to remove the effects of alcoholic intoxication. The vale' 
rianate of ammonia and the aromatic spirits of ammonia abort or 
prevent paroxysms of hysteria. JVervous headache and also migraine 
may sometimes be cured by the various preparations of ammonia ; but 
of these the muriate is exceptionally serviceable. Indeed, Dr. Anstie 
affirms that this agent, if given early enough, seldom fails to cut short an 
attack of migraine. It should be administered in doses of from ten to 
twenty grains. In myalgia or muscular neuralgia, it is equally effective 
according to the same authority: ]J. Ammonii muriat., §j; ext. cimi- 
cifugae, fl 3 ij ; glycerinse, aquae laur. cerasi, aa 3 j. M. Sig. A tea- 
spoonful three or four times a day. In ether neuralgia? the muriate 
of ammonia is occasionally useful, but by no means so curative as in 
migraine and myalgia. 

The preparations of ammonia are classed with the stimxdant expec- 
torants.. It is ah interesting fact, in this connection, that they are elimi- 
nated largely by the lungs ; and it is probable, indeed, that in thus 
escaping they stimulate secretion and liquefy the products of inflamma- 
tion. In bronchorrhoea and chronic bronchitis, muriate of ammonia 
renders important service. It is given in extemporaneous prescriptions 
with extract of liquorice, and may be combined with other stimulating 
expectorants when no incompatibility exists : IJ.- Ext. eucalypt., fl 3" j ; 
ammonia muriat., 3 ij ; ext. glycyrrhiza, 3 ij ; glycerinae, § iij. M. 
Sig. A teaspoonful four or six times a day. "When great depression 
exists in pneumonia, carbonate of ammonia is given with advantage. 
It should be remembered that to stimulate the heart merely, when 
an obstacle exists in the pulmonary circulation, is of doubtful utility ; 
but ammonia liquefies the exudation, and thus removes obstruction 
of the air-sacs, hence it becomes a remedy of great value during this 
stage up to the period of crisis. When there is much adynamia in 
these various pulmonary inflammations, the carbonate of ammonia 
is frequently prescribed in infusion of senega, a stimulating expecto- 
rant. 

Extraordinary success has been claimed for carbonate of ammonia in 
variola, scarlatina, rubeola, and erysipelas. A convenient mode of 
administration is to dissolve the carbonate in the solution of the ace- 



20-4 AGENTS INCREASING WASTE. 

tate. The indications for the use of the carbonate are, feeble circula- 
tion, cyanosis, delirium. As these are self-limited diseases, the mild 
cases do quite as well without drugs. 

Carbonate and acetate of ammonia are much prescribed in continued 
fevers — the latter as a so-called febrifuge ; the former when decided 
adynamia ensues. In typhoid the diarrhoea may be increased by the 
solution of the acetate. As in typhus and typhoid the ammonia in the 
blood is increased above the normal, it has seemed to the author im- 
proper practice to administer ammonia as a remedy in these diseases, 
and his observations have convinced him that it has no good effects 
which cannot be better procured by other means. 

The muriate of ammonia is said to be an excellent ernmenagogue in 
from ten to twenty grains. 

Local Uses of Ammonia. — Ammoniacal gas, cautiously inhaled, 
sometimes gives relief in acute catarrh, and in hay-asthma. Its good 
effects are limited, however, to that stadium of these maladies in which 
the morbid action is confined to the nasal passages, and the discharge 
is yet serous rather than purulent. The pain and smarting which attend 
the stings of insects are alleviated by the application of diluted aqua 
ammonia?. The strong aqua ammonias should be at once applied to the 
bite of venomous serpents, and of rabid animals. 

Ammonia is frequently employed as a counter-irritant in the form of 
the well-known volatile liniment. As a vesicant it is also used when a 
prompt action is desired, but it is rather uncertain. 

A solution of sal-ammoniac in alcohol and water is an excellent dis- 
cutient application in inflammatory swellings: I>. Ammonii muriat., 
3 ij ; spts. vini rectif., aquae, aa, § ij. M. Sig. Lotion. Cloths moist- 
ened with the solution can be frequently applied, and the cases in 
which it is applicable are the following : Orchitis, inflamed joints, 
sprains, and local and external inflammations generally. 

Authorities referred to : 

Anstie, Dr. F. E. On Muriate of Ammonia as a Remedy for some Nervous Disor- 
ders. The Practitioner, vol. L, p. 356. Ibid., vol. xi., p. 31S. 

Ibid. Neuralgia and its Counterfeits, pp. 190, 232. 

Bellini, Dr. Ranieri. The Action of Ammonia and its Preparations. British 
Medicaljournal, 1874, p. 415. 

Brunton and Fayer, Drs. Proceedings of the Royal Society, No. 149, 1874, p. 132. 

Koehler, Dr. Hermann. Handbuch der physiologische Therapeutik und Materia 
Medica, erste Halfte, Gottingen, 1875, p. 229, Ammonii preparata. 

Lange, Dr. Archiv fur experimentelle Patholagie und Pharmalcologie, 1874, p. 225. 
The action of ammonia on the human organism. 

Nothnagel, Dr. Hermann. Handbuch der Arzncimitlellehre, Berlin, 1870, p. 540. 

Stevenson, Dr. Thomas. Gufs Hospital Reports, Series HI., vol. xvii., p. 225. Poi- 
soning by liquor ammonia;. 

Taylor, Dr. A. S. On Poisons, Philadelphia edition, p. 299. 



BARIUM. 205 

BARIUM AND ITS PREPARATIONS. 

Barii Chloridum. — Chloride of Barium. Occurs in colorless, trans- 
lucent tablets. It is soluble in diluted alcohol, and freely and entirely 
soluble in water. Dose, gr. ss — gr. v. It may be administered in pill 
form, or in solution, when it should be given well diluted with water. 

Antagonists and Incompatibles. — Sulphates, phosphates, and 
carbonates, and most of the salts of organic acids, are incompatible 
with it. Nitrate of silver decomposes it. "When it is prescribed, it 
were better to avoid combinations, owing to the numerous incompati- 
bilities to which it is subject. The sulphates are ready antidotes, as 
sulphates of magnesium, or sodium. 

Synergists. — The alkalies, and metallic salts from the therapeutical 
standpoint, increase its action on the retrograde metamorphosis. Ergot 
and digitalis favor its influence over the sympathetic system. 

Physiological Actions. — The soluble salts of barium have a dis- 
agreeable, bitter, and astringent taste. In a full medicinal dose irri- 
tation of the stomach is caused, and a sense of heat and burning is 
developed at the epigastrium. In one case (Ferguson) symptoms of 
poisoning came on in a week, produced by one-twelfth of a grain of 
chloride of barium, administered three times a day, the whole amount 
taken being two and a half grains. The symptoms were extreme ex- 
haustion and nervousness. An idiosyncrasy must have existed here, 
as so small an amount would not, under ordinary circumstances, have 
produced such decided effects. The usual symptoms in cases of poi- 
soning are intense anguish, free salivation, great thirst, loss of voice, 
violent vomiting and purging, dilated pupils, frequent micturition, 
respiration slow and labored, pulse slow, increasing weakness, and 
finally complete paralysis of the extremities. The intelligence is pre- 
served until near the end, when convulsions and coma come on. The 
post-mortem rigidity is very decided. There are present very con- 
siderable bronchial effusion and hyperemia of the lungs, the heart is 
distended with black blood, and the brain is engorged. The stomach 
presents the usual appearances ; there is intense hyperemia, and 
sometimes perforation of this organ. The quantity necessary to cause 
death varies greatly — two and a half grains have brought on serious 
symptoms, and half a teacupful of the carbonate has been recovered 
from. One drachm of the chloride has caused death in seventeen hours, 
and one ounce of the same salt in one hour (Woodman and Tidy). 

The effects on animals have been studied by Onsum, Cyon, Buhm, 
and myself (unpublished). Onsum held that the symptoms produced 
by the soluble salts of barium, when injected into the blood, were due 
to the formation of the insoluble sulphate. Cyon criticises this view, 
and shows that it is incorrect. The most elaborate, as it is the most 
recent, account of the physiological effects of the barium salts is that 



206 AGENTS INCREASING WASTE 

of Bohm. The statement to follow is based on this paper chiefly and 
on the author's personal researches. In frogs, after injection of the 
chloride into the lymph-sac, extension and rigidity of the voluntary 
muscles ensued, followed by relaxation and paresis. The belly becomes 
distended and the intestines are thrown into active movements ; the 
mouth is held wide open and a watery fluid continually escapes, "while 
from the skin a mucus-like secretion exudes. When given to warm- 
blooded animals by the stomach, profuse secretion takes place, active 
peristalsis of the bowels and copious alvine discharges, and free urina- 
tion follow, but not until about a half -hour after the ingestion of the 
poison. If thrown into the veins the same symptoms arise immedi- 
ately ; in either case tonic and clonic convulsions followed by paraly- 
sis occur ; the pupils dilate ; the heart is slowed, but its contraction is 
more energetic ; the tension increases enormously in the arterial system 
after a preliminary fall, and finally insensibility and coma terminate 
the action. Very large doses, suddenly precipitated on the heart by 
injection into the jugular vein, will induce paralysis both of the heart 
and lungs. With the peripheral paralysis labored breathing ensues, 
due to paresis of the respiratory muscles, and death is caused rather 
by this than by cessation of the heart's action, when the poison is in- 
troduced subcutaneously. The paralysis in animals begins in the hind 
extremities. This paralysis is preceded by fibrillary trembling and 
clonic spasms mixed with tonic rigidity. The muscular contractility 
is entirely abolished when the paralysis is complete. On the nervous 
system of organic life barium chloride acts as a stimulant. The strong 
cardiac contractions, the dilated pupil, the energetic peristalsis of the 
bowels, the closure of the lumen of the intestines and also of the blad- 
der, and the almost complete approximation of the peripheral vessel- 
walls, are the proofs of this excitation. 

Therapy. — Having actions in some respects like digitalis and ergot, 
barium salts are indicated in diseases to the treatment of which these 
remedies have been applied. Influenced by the observations of Bohm, 
probably, Dr. Flint, of Leeds, England, has employed the chloride of 
barium successfully in the treatment of aneia-ism. The case was one 
of abdominal aueurism, in a woman of sixty-five. Tufnell's treatment 
had been carried out faithfully for five months without success, and 
iodide of potassium, for some unexplained reason, could not be taken. 
Chloride of barium was, after careful consideration, selected, and one- 
fifth of a grain three times a day was administered three or four weeks, 
when it was increased to two-fifths. The curative effect was very mani- 
fest, for after nearly five months of continued use of the same remedy 
the tumor was so reduced that it could be scarcely felt. Chloride of 
barium will probably prove useful in hemorrhage, in acute congestion 
of organs, in atony of the intestines with deficient secretions, in atony 
of the bladder, in weakness of the heart with low arterial tension, etc. 



VEGETABLE ACIDS. oq 7 

VEGETABLE ACIDS. 

Acidum Aceticum. — Acetic acid. Liquid ; specific gravity 1.047. 
Colorless, having a pungent and characteristic odor. Of this acid one 
hundred grains neutralize sixty grains of bicarbonate of potassium. 

Acidum Aceticum Dilutum. — Dilute acetic acid. One part of the 
acid to seven parts of water. 

Acetum. — Vinegar. Impure dilute acetic acid, prepared by fer- 
mentation. 

Acidum Citricum. — Citric acid. In colorless crystals, freely soluble 
in -water and soluble in alcohol. One hundred grains of citric acid 
neutralize one hundred and fifty grains of carbonate of potassium. 

Acidum Tartaricum. — Tartaric acid. In colorless crystals, wholly 
or almost wholly dissipated by heat, and readily soluble in water. One 
hundred grains of tartaric acid saturate one hundred and thirty-three 
and a half grains of bicarbonate of potassium. 

Antagonists and Incompatibles. — The alkalies are the chemical 
antagonists ; yet, from the physiological point of view, the ultimate 
results of their action place them in the same division of remedial 
agents. Therapeutically, the acids are antagonized by those agents 
which promote constructive metamorphosis. 

Synergists. — The alkalies and agents promoting w r aste favor the 
therapeutical actions of the vegetable acids. 

Physiological Actions. — The vegetable acids, undiluted, have a 
sharp, pungent, and rather acrid taste ; but, when considerably diluted, 
they are rather agreeable and refreshing. They have the property to 
diminish the sense of thirst, to abate heat and the restlessness of fever. 
In large quantity, they possess considerable caustic power, producing 
gastro-enteritis and the systemic symptoms belonging thereto. These 
systemic symptoms, especially the slowing of the heart, have been in- 
correctly, the author thinks, attributed to a special power of these 
agents to affect the action of the heart. 

There can be no doubt that these acids obey the chemical laws of 
combination, and unite with alkalies to form salts, in which form they 
enter the blood. The most important question connected with the 
physiological action of these agents is, the disposition of them in the 
blood. The most recent and elaborate examination of this point is the 
" Memoir" of Friedrich Walter. This research appears to have deter- 
mined that these acids do not have the power to neutralize the alkalinity 
of the blood, as has heretofore been supposed. That they are in part 
destroyed in the organism by the ozonizing action of the blood, seems 
undoubted. Carbonic acid is one of the products, and the presence of 
this, we may assume, accounts for the increased acidity of the blood and 
of the urine, which follows the administration of these agents. 

They are eliminated by the intestinal canal, and chiefly by the kid- 



208 AGENTS INCREASING WASTE. 

neys. They increase secretion from the intestinal mucous membrane, 
and are apt to produce tormina, flatulence, and diarrhoea. It is probable 
that these intestinal effects are in part due to the fact that the salts, 
formed by combination of the acids in the canal, escape absorption and 
act locally as they descend. 

These acids, or the salts formed by their combination, have a decided 
power to promote diuresis. In this result all of the urinary constituents 
are included ; but it is chiefly the water which is increased. To these 
general statements some exceptions must be made. Thus, citric and 
acetic acids are entirely destroyed in their passage through the organism ; 
benzoic acid is converted into hippuric ; and tartaric, citric, and malic, 
are converted into carbonic after combination with alkali only. Further- 
more, benzoic acid does not increase any of the urinary constituents. 

Ultimately, wasting and emaciation, a watery condition of the blood, 
a scorbutic state, indeed (Bence Jones), are the results of the action of 
these agents. 

Therapy. — Acetic acid applied to the skin has some superficial 
caustic property. This is made use of to cure small warts and vegeta- 
tions of the shin. It is applied with a pine stick. Parasitic affec- 
tions of the skin are similarly treated, as, for example, pityriasis. 

Internally the acids, chiefly citric, in the form of lemonade, are used 
as a refreshing drink in fevers. They allay restlessness by relieving 
thirst, and they also act upon the skin and kidneys. Lime-juice is the 
most important antiscorbutic, and constitutes part of the equipment of 
every vessel on long voyages. It should not be forgotten that the use 
of lemon-juice may cause precipitation of uric acid, and thus favor the 
formation of calculi, as has been pointed out by Bence Jones. 

Lemon-juice was at one time the fashion in the treatment of acute 
rheumatism ; but more efficient remedies have taken its place. 

Acids are serviceable in various disorders of the digestive tract ; 
given before meals, they check the formation of acid, and thus relieve 
acidity. An acid and dry wine — as, for example, a Rhenish wine — may 
sometimes serve a useful purpose. The juice of a lemon may be taken 
before meals with the same object. But it is true that the mineral 
acids are to be preferred for this purpose. Very injurious effects are 
produced by the long-continued use of lemon-juice in such cases. It is 
sometimes taken by young ladies to keep down the formation of fat ; 
but it accomplishes this object by impairing digestion. 

Authorities referred to : 

Jones, Dr. H. Bence. Lectures on Materia Medica. The Medical Times and Gazette, 
October, 1854, p. 408. 

Parkes, Dr. E. A. On the Urine, 1860, p. 146. 

Walter, Friedrich. Untersuchungen iiber die Wirhung der Sauren auf den thieris- 
chen Organismus. Archiv f. exper. Pathol, it. Phar., 187V, p. 148. 



SULPHUROUS ACID. 209 



SULPHUROUS ACID AND THE SULPHITES. 

Acidum Sulphurosum. — Sulphurous acid. A colorless liquid hav- 
ing the odor of burning sulphur, and a sulphurous, sour, and somewhat 
astringent taste. Dose, m. v — 3 j. 

Sodii Hyposulphis. — Hyposulphite of sodium. In large, colorless, 
transparent crystals, having a bitter, slightly alkaline, and sulphurous 
taste. It is soluble in one and a half part of water at 60°, and insolu- 
ble in alcohol. Dose, grs. v — 3j. 

Sodii Sulphis, — Sulphite of sodium. In white, efflorescent pris- 
matic crystals, soluble in four parts of cold, and in less than one part 
of boiling water. It has a sulphurous taste, and a feeble alkaline reac- 
tion. Dose, grs. v — 3j. 

Potass ii /Sulphis. — Sulphite of potassium. In white, opaque frag- 
ments or powder, very soluble in water. It has a saline and sulphurous 
taste. Dose, grs. iij — grs. x. 

Antagonists and Incosipatibles. — The mineral acids — including 
sulphuric — decompose the sulphites and hyposulphites. All oxidizing 
substances are incompatible. These preparations have a great affinity 
for oxygen, and the sulphites readily become sulphates. 

Synergists. — All remedial agents which arrest fermentative pro- 
cesses promote the therapeutical activity of sulphurous acid and the 
sulphites. 

Physiological Actions. — Sulphurous acid is a disinfectant and de- 
odorizer. It attacks organic matter with energy, by virtue of its affinity 
for oxygen. It is very destructive to the lower forms of life, bacteria, 
fungi, etc. Sulphurous-acid gas inspired produces great irritation of 
the glottis, and an intensely suffocative feeling. In sufficient quantity 
it produces violent inflammation of the air-passages. As by combina- 
tion with oxygen sulphuric acid is formed, the destructive effect as- 
cribed to sulphurous acid is in reality chiefly due to sulphuric. 

The sulphites exposed to the air rapidly absorb oxygen, and- pass to 
the state of sulphates. The hyposulphites are more constant than the- 
sulphites. In the stomach, by the acid of the gastric juice, these salts 
are in part decomposed and sulphurous acid is given off; in part they 
are converted into sulphates. They are undoubtedly absorbed as sul- 
phates, and are eliminated partly by the intestinal canal, but chiefly by 
the kidneys, as sulphates. The author demonstrated these facts, soon 
after the publications of Dr. Polli led to an enthusiastic administration 
of these remedies in the zymotic diseases. 

Theeapy. — Dilute sulphurous acid is one of the numerous local ap- 
plications considered efficacious in mercurial stomatitis, aphtha?, mu- 
cous patches, ulcers of the tonsils, and in diphtheria. In all of these 
affections the diluted acid may be applied directly to the diseased sur- 
face by a mop, a sp nge-probang, or in the form of spray. A more 
15 



210 AGENTS INCREASING WASTE. 

easily-managed application is a solution of the sulphite of soda ( 3 j — 
§ j ) in water. Sulphurous-acid spray is a good local application in 
syphilitic and tuberculous laryngitis. Cases of chronic bronchitis, with 
profuse expectoration of a fetid character (bronchorrhcea), are some- 
times improved by inhalations of sulphurous-acid gas, or of the acid in 
the form of spray. Notwithstanding the confident assertions of Dewar, 
there is no reason to suppose that sulphurous-acid-gas inhalations can 
modify in any way the progress of phthisis. 

In certain kinds of vomiting of a yeast-like material, especially when 
sarcina are present in the vomited matters, the sulphites are often cura- 
tive. Vomiting of acid matters, pyrosis, and indigestion, due to acid 
fermentation of the starchy and saccharine elements of the food, are 
relieved by sulphurous acid ( m. v — 3 j, well diluted), or, but less effi- 
ciently, by sulphite of soda (3j — 3 j). The result in these cases is, no 
doubt, due to the power which sulphurous acid has of arresting fermen- 
tation processes. 

After the publications of Dr. Polli, of Milan, extravagant expecta- 
tions were entertained of the curative power of the sulphites in the 
zymotic diseases generally, and in all the various forms of septic dis- 
eases. Unfortunately, these expectations have not been realized, and 
the sulphites are no longer employed with this view in any of these 
disorders ; and, as Braun and Bernatzik have shown, they are not 
only nauseous in taste but they produce more or less irritation of the 
intestinal canal, and do not in any case modify the course of the dis- 
ease. 

Externally applied, sulphurous acid and the hj T posulphites and sul- 
phites are in some maladies extremely serviceable. 

As a disinfectant and deodorizer sulphurous acid is at the same 
time efficient, easily managed, and economical.. Sulphurous acid is the 
product of the combustion of sulphur in the open air ; hence, to disin- 
fect rooms', it is necessary only to close all egress and fill them with the 
fumes of burning sulphur. It is to be remembered that sulphurous acid 
is injurious to many fabrics : the sulphites are colorless and soluble. 

Sulphurous acid is an efficient application to chilblains: I>. Acid, 
sulphurosi, 3 iij ; glycerini, 3j; aquae, sjss. M. In parasitic sMn-dis- 
eases, the sulphites, hyposulphites, and sulphurous acid, are used to 
destroy the parasites. The following formula is employed by Startin 
in these affections : B- Sodii hyposulphitis, 5 iij ; acid, sulphurosi dil., 
§ss; aquae q. s. ad § xvi. Fox recommends the following formula in 
tinea versicolor and in pruritus vulvae : B . Sodii hyposulphitis, 3 iv ; 
glycerini, 3 ij ; aquae destil. ad 3 vi. 

Sulphurous acid is an excellent application to ill-conditioned, slough- 
ing, or gangrenous wounds. It -was found to be very successful in 
these cases, at the English hospital at Metz, during the Franco-German 
War. 



SULPHURETS. 211 

Authorities referred to : 

Bartholow, Dr. Roberts. The Lancet and Observer, Cincinnati, 1665. 

Buaun and Bersatzik, Profs. Wiener median, Wochenschrift, Nos. 94-99, 1809. 

Bird, Dr. Robert. The Practitioner, voL ii., p. 247. 

Erysdaxe, Dr. Charles R. 'The Lancet, July 24, 1869. 

Dewar, Dr. James. On the Application of Sulphurous-Acid Gas to the Prevention, 
Limitation, and Cure of Contagious Diseases, Edinburgh, 1866. 

Fergcs, Mr. Tlie Lancet, November 26, 1860. 

Fox, Dr. Tilbury. Skin Diseases, New York, 1873. 

Miller, Dr. Edinburgh Medical Journal, September, 1869. 

Polli, Prof. Various Papers. Abstracts in Schmidt's Jahrb'ucher der gesammlen 
Medicin, etc. 

Purdon, Dr. H. S. British Medical Journal, May 9, 1868. 

Sulphides (Sulphurets). — Potassii Sulphuretum. Sulphide of po- 
tassium has a brownish-yellow color when freshly broken. It dissolves in 
water, with the exception of a slight residue, and forms an orange-yel- 
low solution, which exhales the odor of hydrosulphuric acid. Dose, gr. 

j— gr- v - 

Calcii Sulphuretum. — Sulphide of calcium. Unofficial. A greenish- 
gray paste, having a strong odor of sulphuretted hydrogen. Dose, gr. j 
— gr. v. 

Antagonists and Incompatibles. — Solutions of the sulphides are 
decomposed by the mineral acids, sulphuretted hydrogen being liber- 
ated and sulphur precipitated. Solutions of the metals, generally, are 
also incompatible with the sulphides of potassium and calcium, for, in 
the decomposition which ensues, the metals are precipitated in the form 
of insoluble sulphides. Hence it is that these preparations have been 
proposed as antidotes to the metallic poisons. Chlorine-water, chlo- 
rides of sodium and potassium, sulphate of iron, etc., are chemical anti- 
dotes. 

Synergists. — All agents promoting waste are, therapeutically con- 
sidered, synergistic. Alkalies favor their action, both chemically and 
physiologically. 

Physiological Actions. — These preparations have a decidedly nau- 
seous taste and smell, and are somewhat irritant. In the stomach they 
excite a sense of heat, and in sufficient quantity cause gastro-enteritis 
with all the attendant symptoms belonging to irrritant poisons. Dis- 
agreeable eructations of sulphuretted hydrogen take place when they 
are administered medicinally, owing to the reactions in the presence of 
an acid alluded to above. The}' increase secretion from the gastroin- 
testinal canal, and are laxative. The fetor of the stools is increased by 
their use, a result not altogether due to the evolved sulphuretted hydro- 
gen, but to the increased action of those intestinal glands concerned in 
elimination. As the sulphides pass easily to the state of sulphates by 
the action of oxygen, 't may be assumed that a part of their physio- 
logical effects is produced by the latter salts. They, however, un- 



212 AGENTS INCREASING WASTE. 

doubtedly exercise a toxic action on the blood, impairing the red blood- 
globules, and increasing the amount of effete material. Emaciation 
muscular weakness, and trembling, and a feeble circulation, are results 
of their use in large amount, or for lengthened periods. It is true that 
some acceleration of the pulse-rate and increase of secretion of the 
mucous surfaces follow their medicinal administration for a short period 
and in moderate doses ; but the prolonged inhalation of sulphuretted 
hydrogen, or the prolonged internal use of the sulphides, causes great 
anaemia, wasting, and debility. 

Thbrapt. — Although the sulphides are indicated as remedies when 
the secretions of the intestinal glandular appendages are deficient, they 
are too disagreeable to be prescribed under ordinar}- circumstances. 
The water of the well-known Blue Lick Spring, of Kentucky, which is 
almost identical in composition with the famous Harrogate, of England, 
may be substituted for the sulphides in many of the cases in which the 
latter' are useful. 

The Blue Lick water, like the Harrogate, is useful in abdominal 
plethora. A pint taken before breakfast is an efficient laxative, which 
is indicated in cases of habitual constipation from deficient secretion of 
the intestinal juices. Four ounces taken before each meal is an excel- 
lent remedy for obesity. Engorgement of the pelvic viscera in women, 
haemorrhoids in both sexes, when due to torpor of the portal circula- 
tion, are relieved by the same agent. For these purposes the Blue 
Lick water may be taken for several weeks or even months, but its use 
should be discontinued when anaemia; is threatened. In anaemic sub- 
jects, chalybeates and a generous diet should be conjointly adminis- 
tered. The author has observed excellent results from the prolonged 
use of this water in glandular affections, hepatic, splenic, uterine, and 
of the prostate. 

A succession of common boils, scrofulous and other abscesses, are, 
it is said, made to mature, and the expulsion of the pus is favored by 
the use of the sulphides. When abscesses are threatened, and before 
matter has formed, the sulphides, it is claimed, may cause them to abort. 
Small doses (gr. ss — gr. j) frequently repeated (every hour or two) are 
said to be most effective under these circumstances. 

External Uses of tke Sulphides. — A solution of the sulphide of 
potassium ( 3 ss — § j) is an efficient application in scabies. An extem- 
poraneous sulphide may be made by boiling one part of quicklime and 
two parts of sublimed sulphur in ten. parts of water. With this solu- 
tion the parts affected by scabies may be painted over, after preliminary 
cleansing with a warm bath. Sulphur-baths (solution of sulphide of 
potassium in water, as above mentioned) are very excellent applications 
in the chronic forms of psoriasis and eczema. The following formula 
is recommended by Fox in scabies and prurigo : rj. Potassii sulphureti, 
§ vi ; sapon. alb., lb ij ; ol. olivae, Oij ; ol. thymi, 3 ij- M. A milder 



SULPHUROUS WATERS. 213 

preparation is the following : B. Potassii sulphureti, 3 iij ; sapon. moll., 
3 j, aqua) calcis, 3 viij ; alcohol, 3 ij. M. Or the following: 5. Po- 
tassii sulphureti, 3 ss ; aqu;e calcis, 3 xvj. M. For the relief of pityri- 
asis and parasitic skin-diseases. 

The sulphide of sodium (unofficial) being more stable, is better 
suited for the preparation of sulphurous baths. An artificial sulphur- 
ous water, in imitation of the Bar'egcs, is made as follows: B. Sul- 
phidi sodii, soda?, sodii chloridi, aa §ij. M. Sig. A sufficient quan- 
tity for one bath. The Pommade de Bareges of the French is consti- 
tuted as follows: I£. Sodii sulphureti, sodii carbonat., aa 3 ij ; ax.ungise, 
5 ijss. M. 

Sulphur-baths are frequently employed to favor the elimination of 
lead, in cases of saturnine disease. For this purpose, from three to five 
drachms of sulphide of potassium may be dissolved in sufficient water 
for a bath. A sulphide of lead is formed on the skin ; but that the 
sulphur-bath promotes the elimination of lead by the sweat-glands more 
than a simple warm bath, seems hardly credible. 

The disagreeable odor of the sulphides, in ointment or solution, may, 
it is said, be much modified by the addition of a little oil of aniseed. 

Authorities referred to: 

Fox, Dr. Tilbury. Skin Diseases : Their Description, Pathology, etc., second Amer. 
ican edition. 

Gubler, Dr. Adolph. Commentaires Tlierapeutiques du Codex Medicamentarius, Paris, 
1868, p. 502. 

Lewis, Locis. The Lancet, March 14, 1874, p. 393. 

Mactherson, Dr. John. The Baths and Wells of Europe, London, 1873. 

Ringer, Dr. Sidney. A Handbook of Therapeutics, New York, 1872, p. 66. 

Trousseau et Pidoux. Trai.te de Therapeulique el de Maliere Medicate, vol. ii., p. 
863, et seq. 

United States Dispensatory, thirteenth edition. 

SULPHUROUS MINERAL WATERS. 
1. North America. 

French-Lick Springs. 

West-Baden Springs, Orange County, Indiana. 

Indian Springs, Martin County, Indiana. 

These waters contain carbonates of soda, potassa, magnesia, and 
lime, and chlorides of sodium, potassium, magnesium, and calcium, and 
sulphates of soda, magnesia, lime, and potassa. The gases are sul- 
phuretted hydrogen and carbonic-acid gas. 

Upper Blue-Lick Springs, Nicholas County, Kentucky. 

Lower Blue-Lick Springs, Nicholas County, Kentucky. 

Big-Bone Springs, Boone County, Kentucky. 

Paroquet Springs, Bullitt County, Kentucky. 

These waters are remarkable for the quantity of sulphuretted hydro- 



214 AGENTS INCREASING WASTE. 

gen which they contain (from 1.02 cubic inch to 3.75). They are rich 
in the chloride of sodium (from 38.700 grains to the pint to 64.567 
grains). They contain also chlorides of potassium, sodium, magnesium 
and calcium, carbonates of soda, magnesia, iron, and lime, sulphates of 
soda, potassa, and magnesia, and appreciable quantities of iodides and 
bromides. 

Alpena Well, Alpena County, Michigan. 

This water contains the large quantity of 4.42 cubic inches of sul- 
phuretted hydrogen to the pint. The proportion of chloride of sodium 
is small (8.532 grains to the pint). The other ingredients are carbonates 
of soda, magnesia, iron, and lime, and sulphate of lime. 

Sharon Springs, Schoharie County, New York. 

Avon Springs, Livingston County, New York. 

Mild sulphuretted waters. The principal salt is sulphate of lime, 
which is found in the different springs, ranging from 11.687 grains to 
13.95 grains to the pint (Sharon). 

Yellow-Sulphur Springs, Montgomery County, Virginia. 

The most important constituents of these waters are sulphates of 
lime, magnesia, soda, potassa, and alumina, and carbonates of lime, mag- 
nesia, and iron. The gas is carbonic acid and sulphuretted hydrogen. 

Greenbrier White-Sulphur Springs, West Virginia. 

Salt-Sulphur Springs, Monroe County, West Virginia. 

Red-Sulphur Springs, Monroe County, West Virginia. 

These springs are nearly alike as respects the composition of their 
waters. They contain chlorides and sulphates, but their principal con- 
stituents are sulphate of lime, sulphate of soda, and sulphate of mag- 
nesia. The Greenbrier Spring and the Red-Sulphur Spring waters 
contain also a peculiar sulphur compound, in regard to the nature of 
which but little is known. 

2. European. 

Harrogate, Yorkshire, England. Season from May to September. 

These waters contain chlorides of calcium, magnesium, potassium, 
and sodium, carbonic-acid gas, and sulphuretted hydrogen. 

Llandrindocl, Wales. 

Saline, chalybeate, and sulphur waters ; rich in chlorides, especially 
of sodium. 

Strathpeffer, Ross-shire, Scotland. 

This is a strong sulphuretted water, and contains sulphate of lime, 
carbonate of lime, sulphate of magnesia, and sulphate of soda. 

Moffatt, south of Scotland. 

The waters contain chloride of sodium (28.07), sulphate of soda, sul- 
phate of lime, and sulphuretted-hydrogen gas. 

Bareges, Hautes-PyrenSes. Altitude, 4,000'. Temperature, 86° to 
113° Fahr. Season from July to September. 



SULPHUROUS WATERS. 2 IT, 

Waters contain sulphide of sodium, sulphate of soda, chloride of 
6odium, etc. 

These waters are used chiefly for bathing- the patients, beginning 
with the colder and passing on to the hotter waters. These springs 
have a special celebrity for the treatment of old wounds, diseases of 
bones, and rheumatic and neuralgic affections. 

Cailterets, Hautes-Pyren6es. Altitude, 3,000', but sheltered. Sea- 
son, June to September. Temperature of baths, 98° to 131° Fahr. 

The composition of the waters is similar to that of those of Bareges, 
but it is more stimulating, and contains a good deal of iodine. It is 
especially advised in incipient tuberculosis, bronchial affections, and 
pelvic diseases of women. 

Eaux-Boimes, Basse-Pyr6nees, near Pau. Altitude, 2,000'. 

Waters sulphurous and saline, similar to but not so exciting as those 
of Bar6ges. This resort is celebrated chiefly for its effects in laryngeal 
diseases and clergyman's sore-throat. 

Challes, Savoy. 

This Avater, according to Macpherson, is one of the most remarkable 
in Europe, and " is the strongest sulphur-well known." It contains 
iodine and bromine, sulphide of sodium, bromide of sodium, etc. 

AiX-la-Chapelle, Rhenish Prussia. Altitude, 450'. Temperature of 
air during season, mean, 63° Fahr. Season from June to September. 

According to Liebig's analysis, these waters contain chloride of so- 
dium (20 grains), bromide, iodide, and sulphate of sodium, carbonate 
of soda (4.9 grains), sulphate of soda (2.1 grains), sulphate of potash 
(1.1 grain), and carbonates of lime, magnesia, strontia, lithia, etc. 
Used by drinking and bathing, and especially in cutaneous diseases, 
rheumatism, syphilis, hepatic disorders, etc. 

Eilsen, Lippe-Schomburg, Northern Germany. 

Neimdorf, Prussian Westphalia. 

These waters contain the sulphates of soda, magnesia, lime, and 
chlorides of calcium and magnesium. They are highly charged with 
carbonic-acid gas and sulphuretted hydrogen. They are useful in gouty 
and rheumatic affections, syphilis, skin-diseases, etc. 

ScMlltznach, Switzerland. Altitude, 1,060'. 

This is a highly-sulphurous water, and is charged with carbonic-acid 
gas and sulphuretted hydrogen. It contains sulphate of soda (9.87 
grains), sulphates of potash and lime, chlorides of potassium and mag-- 
nesium, and carbonates, etc. 

Weilbach, Nassau. Altitude, 420'. 

These \v 7 aters contain bicarbonates of soda (3.123 grains), of lithia, 
of baryta, and of strontia, chlorides of sodium and potassium, carbo- 
nates of lime and magnesia, etc. The gases are carbonic acid and 
sulphuretted hydrogen. 

Therapy or the Sulphur- Waters. — These waters, as a rule, are 



216 AGENTS INCREASING WASTE. 

useful in liver-disorders; they diminish abdominal plethora, &nd con- 
gestion of the portal circulation. They are indicated in malarial affec- 
tions of the liver and spleen. Rheumatism and gout, tuberculosis in its 
inciptency, chronic poisoning by the metals, etc., are certainly benefited 
by the internal use, and by baths of sulphurous waters. Affections of 
the skin, syphilitic diseases, chronic rheumatic affections, etc., are 
especially forms of disease remediable by these waters, used internally 
and in the form of baths. 

Authorities referred to : 

Braun, Dr. Julius. Systematisches Lehrbuch der Balneotherapie. 

Macpherson, Dr. John. Batlis and Wells of Europe. 

Moorman, Dr. J. J. Mineral Springs of North America. 

Valentiner, Dr. Th. Handbuch der allgemeinen und speciellen Balneotherapie. 

Walton, Dr. Geo. E. Mineral Springs of the United States and Canada. 

IODINE AND ITS PREPARATIONS. 

Iodine. — lode, Fr. ; Iod, Ger. ; Iodinium, Latin, U. S. P. 

Iodinium. — Iodine. In bluish-black crystalline scales, having a me- 
tallic lustre ; very slightly soluble in water (1 in 7,000) ; soluble in al- 
cohol (1 in 12), in ether, in a solution of iodide of potassium, and in a 
solution of chloride of sodium. Dose, gr. ss — gr. j. 

Jodoformum. — Iodoform. In yellow crystals, having a saffron-odor. 
Insoluble in water, but soluble in ether, and the fixed and volatile oils. 
May be prescribed in a mixture, containing at least twenty times its 
weight of mucilage to render it properly miscible with water. Dose, 
gr- j— grs- v. 

Liquor Iodinii Compositus. — Compound solution of iodine. Iodine, 
360 grains ; iodide of potassium, § jss ; distilled water, Oj. Dose, m. 
v. — m. xx. 

Tinctura Iodinii. — Tincture of iodine. Iodine, § j ; alcohol, Oj. 
Dose, m. j — m. v. 

Tinctura Iodinii Composita. — Compound tincture of iodine. Iodine, 
| ss ; iodide of potassium, § j ; alcohol, Oj. Dose, m. ij — m. x. 

Uhguentum Iodinii. — Ointment of iodine. Iodine, 3j; iodide of 
potassium, grs. iv ; water, m. vj ; lard, § j. 

Unguentum Iodinii Compositum. — Compound ointment of iodine. 
Iodine, grs. xv ; iodide of potassium, 3 ss ; water, m. xxx ; lard, § j. 

Ammonii Iodidum. — Iodide of ammonium. A white, granular, very 
deliquescent salt, becoming yellowish-brown by exposure. Very soluble 
in water and in alcohol. Dose, grs. ij — grs. x. 

Potassii Iodidum. — Iodide of potassium. In white or transparent 
crystals, wholly soluble in water (4 in 3), and in alcohol (1 in 6). Dose, 
grs. v— 3 j- 

Antagonists and Incompatibles. — Iodine is incompatible with the 



IODINE AND IODIDES. 217 

mineral acids, the metallic salts, the vegetable alkaloids, etc. The 
chemical antidote is starch, or substances containing it, as flour. These 
should be given freely diffused in water. It should be remembered that 
starch is the antidote to free iodine. As, however, the iodide of starch 
is not devoid of activity, in cases of poisoning by iodine, the contents 
of the stomach should be evacuated. It is obvious that the preparations 
of iodine, taken after a meal consisting of amylaceous materials, will 
have their activity impaired by the formation of the iodide of starch, 
the acid of the stomach freeing the iodine from its chemical association. 

Therapeutically, iodine and the iodides are antagonized by all those 
remedies which promote constructive metamorphosis, and by the vaso- 
motor tonics, quinine, digitalis, cold, etc. 

Synergists. — Alkalies, and other remedies which increase waste, 
favor the action of iodine and the iodides. Under some circumstances, 
mercurials are especially synergistic. 

Physiological Actions. — Iodine. — When brought into contact with 
albuminous substances, iodine combines with it and prevents putrefactive 
change. The vapor of iodine, like chlorine, but in a feebler degree, de- 
composes sulphuretted and phosphuretted compounds. It is, therefore, 
justly ranked among the disinfectants. 

Applied to the skin or mucous membrane, iodine, according to the 
extent of the application, is irritant or caustic. It stains the skin yel- 
low, causes a sensation of warmth in small quantity, or of burning in 
larger quantity, and excites a superficial inflammation followed by des- 
quamation. In some subjects the application of iodine-paint causes ves- 
ication. Pure iodine, kept in contact with the tissues, produces a brown 
and dry eschar. The vapor of iodine is very irritant to the broncho-pul- 
monary mucous membrane, causing cough, spasm of the glottis, and in- 
creased flow of mucus. 

Iodine has a hot, pungent flavor, and excites a sensation of heat or 
burning in the stomach. In sufficient quantity, it acts as an irritant 
poison, inflames the mucous membrane of the stomach, and causes super- 
ficial eschars. The amount of iodine necessary to produce toxic symp- 
toms varies greatly, and the variation depends in part on constitutional 
peculiarities, but chiefly on the amount and quality of the food in the 
stomach. "Whether applied to the surface of the skin or taken into the 
stomach, it quickly diffuses into the blood, and enters into combination 
with sodium or potassium, or with both. 

Iodides. — The iodides are among the most diffusible substances. 
They have a bitter, saline, and very disagreeable taste. In a few min- 
utes after being swallowed, the taste of iodide of potassium returns in 
the mouth, and, during a course of this salt, the saliva is constantly 
sharged with it. In the stomach, in considerable doses, they produce 
first a cooling sensation, followed by warmth, and even burning. They 
pass into the blood with great rapidity. It is said that the base is 



218 AGENTS INCREASING WASTE. 

changed in the blood, and the iodides of ammonium and potassium he- 
come iodide of sodium. In the blood they probably undergo no further 
changes, and do not, so for as is known, modify the composition of that 
fluid. At the points of elimination from the free mucous surfaces (nasal, 
faucial, and bronchial mucous membrane), the chemical changes which 
ensue set free ozone, and the irritation there experienced is probably in 
part due to the iodine, separated from its combinations by the action of 
that agent (Buchheim). Elimination doubtless takes place by the bron- 
cho-pulmonary, faucial, and salivary glands, but chiefly by the kidneys. 
The diffusion of the iodides into and out of the blood takes place with 
such rapidity that in fifteen minutes they may be detected in the saliva 
and in the urine. 

Diverse opinions have been expressed in regard to the influence of 
the iodides over the assimilative functions. By the syphilographers it 
is held that the iodides promote constructive metamorphosis, and that a 
gain in body-weight is a result of their use. This opinion is developed 
in this way : The subjects of syphilis in its constitutional form emaciate, 
and their forces are depressed ; but, when the iodides are given them, 
the virus is eliminated, and the organism at once reacts. In the physio- 
logical state the iodides increase waste and the elimination of the prod- 
ucts of waste, and emaciation with a general depression of the vital func- 
tions ensues, when they are administered for lengthened periods. 

Jbdism. — Iodine and the iodides, when given in large quantity, pro- 
duce a state termed iodism. The quantity which will set up this state 
of irritation in one subject will affect another but slightly, if at all ; in 
other words, the susceptibility to the iodine impression varies greatly in 
different individuals. Iodism is manifested by general malaise and rise 
of temperature, frontal headache, coryza, lachrymation, and sometimes 
inflammatory swelling of the eyelids, a bitter, saline taste in the mouth, 
soreness of the throat, hoarseness, and difficulty of swallowing — phe- 
nomena strikingly similar to summer catarrh. Indeed, patients who ex 
perience these sensations for the first time, suppose them to be an acute 
catarrh. Usually the symptoms of iodism subside, notwithstanding the 
dose which caused them may still be taken, or, as it may be expressed, 
a " tolerance " is established. The quantity which at one time may have 
caused violent iodism will not necessarily again do so, although a con- 
siderable interval may have elapsed. Indeed, it is sometimes difficult to 
induce iodism in those who have become habituated to the use of the 
iodides in considerable medicinal doses. 

An eruption of acne, especially on the face, shoulders, and thighs, is 
a very common result of the internal use of the iodides ; hydroa on the 
face and forehead is an occasional consequence, but eczema is more 
frequent, yet less so than acne, which is usual. 

Wasting of the mammae and of the testes has never been observed 
by the author, although he has used the largest doses of the iodides, and 



IODINE AND IODIDES. 219 

for long periods. There is no doubt about their antaphrodisiac effects, 
and it has seemed to the author that permanent loss of sexual power has 
resulted from their long-continued use. 

When it is desirable to avoid iodism, large draughts of water should 
be taken during a course of the iodides. As Rosenthal has shown, large 
dilution of the salt hastens elimination, and thus prevents the more se- 
vere effects of iodism. 

Benedict has experimentally studied the effects of iodine and of 
iodide of potassium on the nervous system. His observations, made on 
frogs, demonstrated that these agents caused paralysis of the heart and 
of the respiration, but there are no facts indicating that on man they 
possess this power. It is true Schule had a case in which such symp- 
toms were induced by injecting the sac of a spina bifida with tincture 
of iodine, but the direct and reflex effects of the injection on the spinal 
cord may have had much to do with the result. The nervous symptoms 
which accompany iodism are apparently due solely to the increase in 
the pulse-rate, the elevation of temperature, and the irritation of the 
broncho-pulmonary mucous membrane. 

Therapy. — A weak solution of the iodide of potassium (grs. j— grs. 
v — 3 j) is a useful application to the mouth in aphthae, mercurial sto- 
matitis, simple sore-throat, tonsillitis, etc. Hypertrophy of the tonsils 
oan usually be cured by the injection of the tincture of iodine into their 
substance. To execute this little operation, an hypodermic syringe, 
with a sufficiently long needle, is necessary. 

The vomiting of pregnancy can sometimes be greatly relieved by 
drop-doses every hour or two, of the tincture of iodine. This, like all 
other remedies for this disorder, is very uncertain, and precise indica- 
tions for its use have not hitherto been ascertained. Catarrh of the 
duodenum, catarrh of the biliary ducts, and the jaundice dependent 
thereon, are, after the acuter symptoms have subsided, cured by small 
and frequently-repeated doses of the iodide of ammonium (grs. j — iij in 
water every two, three, or four hours). This is one of the best reme- 
dies for the first stage of cirrhosis. The efficacy of the iodide is 
increased by combination with arsenic : R. Ammonii iodid., 3 j ; liq. 
potassii arsenitis, 3 ss ; tinct. colombsc, 3 ss ; aqua;, 3 jss. M. Sig. 
A teaspoonful three times a day, before meals. 

The preparations of iodine and the iodides are, generally speaking, 
contraindicated in all inflammatory states of the intestinal canal ; but in 
passive haemorrhage, and diarrhoea from atony of the mucous mem- 
brane, the tincture or compound solution of iodine in small doses — one 
or two drops — frequently repeated, renders important service (Schmidt). 

Large doses (grs. xv — 3 ss) of the iodide of potassium, three or four 
times a day, often afford remarkable relief in aneurism, and sometimes 
effect a cure. This mode of treatment is adapted to internal aneurisms 
60 situated as to be beyond the reach of surgical means. The author 



220 AGENTS INCREASING WASTE. 

has seen several instances in which great relief was experienced, and 
one case certainly in which a cure apparently resulted. He is, there- 
fore, able to confirm the observations of Chuckerbutty, Roberts, Balfour, 
and others. 

The iodides are unquestionably serviceable in acute catarrh. The 
action is local and substitutive. A grain of the iodide of ammonium 
every two hours has seemed to the author the best mode of applying 
the remedy. In summer catarrh or hay-asthma, the best results are 
obtained by the use of larger doses, and the efficacy of the iodides is in- 
creased by combination with arsenic. R. Potassii iodidi, §j; liq. po- 
tassii arsenitis, 3 j ; aquas, § iv. M. Sig. A teaspoonful every four or 
six hours. With the internal use of the iodides may be combined the 
local use, to nares and fauces, of the following solution : R. Tinct. iodinii, 
3 j ; acid carbol., gtts. x ; aquas destil., § iv. M. Sig. Apply with a 
post-nasal syringe. Local applications will be effective, when the mor- 
bid action is confined to the nares and fauces. 

The iodide of potassium is one of the most effective remedies which 
we possess for spasmodic asthma. But it is not adapted to all cases 
arising under various conditions — a fact which explains the difference of 
opinion on the subject between Williams, Salter, and others. It is most 
beneficial when the asthmatic seizures are induced by an acute bronchial 
catarrh, the nervous symptoms being reflex ; and when there occurs dur- 
ing an asthmatic attack profuse bronchial secretion. Salter, however, 
holds that we possess no exact indications for its use, and that cases the 
most diverse .are sometimes benefited in a remarkable manner. As re- 
gards dosage, from fifteen to thirty grains every two, three, or four 
hours, according to the severity of the seizure, is usually the necessary 
quantity. 

Chronic bronchitis, with profuse secretion (bronchorrhcea), is fre- 
quently improved by the iodides, more especially the iodide of ammoni- 
um. The efficacy of this remedy is increased by the conjoined adminis- 
tration of arsenic. In capillary bronchitis, the author has witnessed 
most astonishing relief by the rapid administration of iodide of ammo- 
nium in small doses. It may be combined with the carbonate, or with 
the stimulant expectorants. To prevent caseation of the inflammatory 
exudations of catarrhal and fibrinous pneumonia, no remedy is more 
efficient than the iodide of ammonium. To lessen the effect of this 
remedy on the tissue-changes, arsenic should be combined with it, and 
every means used to support the body nutrition. The iodide of potas- 
sium is one of the remedies resorted to in chronic pleurisy, to promote 
absorption of effusions. In these cases the chest is painted with the 
tincture, and the iodides are administered steadily for a considerable 
period. 

Affections of the broncho-pulmonary mucous membrane, alluded to 
above, in which there is profuse exudation, all inflammatory symptoms 



IODINE AND IODIDES. 221 

having- subsided, are advantageously treated by iodine inhalations. The 
method which the author has found most convenient is the following: 
A small, wide-mouthed bottle, containing a moistened sponge, is placed 
in a vessel of hot water. The tincture of iodine (gtts. v — gtts. x) is 
dropped upon the sponge, and as the vapor of iodine rises, is inhaled 
with the vapor of -water. This inhalation is serviceable in acute catarrh, 
hay-asthma and chronic bronchitis. The carbolate of iodine (tinct. 
iodinii, 3 ss ; acid, carbol., 3 j) may be used instead of the simple tinct- 
ure of iodine. 

But few affections of the brain, non-specific in origin, are benefited 
by the iodides. According to Niemeyer, the iodide of potassium given 
to iodism has in few instances cured basilar meningitis. The author, 
who has used it faithfully in various cases, has not been so successful. 
Trousseau et Pidoux express their disbelief in the reported cures of 
tubercular meningitis by this agent. 

No remedy is more efficient in the treatment of certain glandular 
enlargements of the thyroid, spleen, and lymphatic glands. Goitre is 
curable by the internal and external application of iodine, when it con- 
sists of simple hypertrophy of the gland-elements. Cystic and calcare- 
ous degeneration of the thyroid are unaffected by the use of iodine prep- 
arations never so vigorously used. One of tbe best remedies for true 
goitre, as will be seen hereafter, is the unguentum hydrarg. iodidi rubri. 
Enlarged spleen, when it consists merely of an hypertrophy of the organ 
(chronic splenitis), is cured by the internal use of the iodides conjoined 
with the local use of iodine-paint, or ointment of the red iodide of mer- 
cury. The enlargements of the spleen and liver, with functional de- 
rangement of these organs, which are caused by malarial disease, are 
most effectually removed by moderate doses, frequently repeated, of the 
iodide of ammonium. The author's experience justifies him in strongly 
urging the combined use of iodide of ammonium and arsenic in chronic 
malarial poisoning. 

The prolonged administration of iodide of potassium has appeared 
in some instances to have retarded the changes which ensue in chronic 
J3 right's disease (fibroid degeneration), and to have improved the con- 
dition of the patients. 

The utility of the iodides is most conspicuous in certain constitutional 
states. The expectations which were at first entertained of the cure of 
scrofula by iodine and its preparations have not been realized. The 
iodides are unquestionably useful in the scrofulous (so called) enlarge- 
ments of the lymphatic glands, but cod-liver oil and suitable hygienic 
means are more influential in improving the strumous diathesis. The 
preparations of iodine are effective only when simple hypertrophy of 
the lymphatic glands has taken place ; if they have undergone casea- 
tion, or have proceeded to suppuration, no medicine has any influence 
over them. 



222 AGENTS INCREASING WASTE. 

The most important therapeutical applications of the preparations of 
iodine are in the treatment of constitutional syphilis. ■ For the primary 
and secondary stage, mercury is generally admitted to be best; but for 
tertiary symptoms no remedy at all approaches the iodide of potassium. 
In the secondary affections of the skin, mercury, especially if it have not 
been given for the primary troubles, is to be preferred in the papular, 
tubercular, squamous, and pustular syphilides ; iodide of potassium in 
the ulcerating, especially if the patient is cachectic. It may be stated 
in general that the preparations of iodine are indicated when the patient 
is under the mercurial cachexia. On the other hand, it is well known 
that sometimes even when the tertiary symptoms have not been relieved 
by a thorough course of iodides, mercury will quickly remove them. 
But this fact does not invalidate the rule that the iodides are specially 
serviceable for the tertiary period. 

No therapeutical fact is more conspicuous than the cure of syphiloma 
of the nervous system by iodides. Mental disorders, epileptiform seiz- 
ures, paralytic states, etc., dependent on gummata, nodes, etc., are 
usually removed in a manner little short of magical. JYeuralgia of the 
fifth (tic-douloureux), the pain being nocturnal chiefly, or nocturnal 
pain in the head, is similarly promptly cured. In syphilitic affections 
of the brain, more imperatively than in the same affections of other or- 
gans, are large doses of the iodide of potassium required. The limita- 
tion of the dose depends entirely on the physiological susceptibility of 
the patient, and the influence exerted over the progress of the case. 
Hence the dose may vary from ten grains to a drachm every four hours, 
or three or four times a day. The symptoms of iodism — the use of the 
agent to saturation — should be induced ; for this effect is the only meas- 
ure of the therapeutical power of the remedy. The more promptly 
iodism can be induced, the better, for the soft nervous tissue may be 
quickly and irreparably damaged by syphilitic deposits and new growths. 
Syphilitic paraplegia is equally amenable to the same means ; but, as 
above remarked, much depends on the promptness with which the iodide 
is used. 

Recent experience has conclusively shown the curative power of 
iodine in malarial fevers. Thus three hundred consecutive cases were, 
with few exceptions, promptly arrested (Anderson). In some cases 
no paroxysm occurred after the medicine was administered ; some- 
times the attacks persisted for two. or three days, but then the re- 
lief was complete. The official compound tincture of iodine may be 
prescribed — for adults, ten to fifteen minims, three times a day, well 
diluted, and before meals. Carbolic acid, itself having considerable 
anti-periodic power, may be combined with the compound tincture of 
iodine. IJ. Tinct. iodinii comp., § i j ; acid, carbolic, 3 j. M. Sig. 
Ten to fifteen minims three or four times a day. The official tincture 
of iodine is given by many practitioners. If quinia may be necessary 



IODINE AND IODIDES. ±2)! 

to break up the paroxysms, iodine is highly useful in the interim, as 
has been indicated. 

The use of the compound solution of iodine during the course of 
the first and second week of typhoid fever is known in Germany as 
the " specific treatment." A very considerable reduction in mortality 
appears to have followed this method. The solution of iodine or the 
tincture is administered regularly three times a day, well diluted with 
Water. When it does good, the temperature falls, the nausea lessens, 
and the diarrhoea is restrained within safe limits. 

Chronic rheumatism, when there are present thickening of the 
fibrous tissues, and inflammatory depositions about joints, tendons, peri- 
osteum, and nerve-trunks, is often very signally benefited by the iodides. 
The cases in which these remedies prove so serviceable are most proba- 
bly due to syphilitic, mercurial, saturnine, or other constitutional 
causes. There are, in our modern life, many ways in which these 
mineral poisons enter the organism, and it is probable that they are 
often undiscovered and even unsuspected causes of rheumatic symptoms. 
Lumbago, sciatica, nod. paraplegia, apparently of rheumatic origin, and 
curable by the iodides, may not unfrequently be caused by syphilis, 
mercury, copper, tin, or lead. 

The various accidents caused by the metals above named, especially 
the mercurial and saturnine, are removed by the use of the iodides, no- 
tably by the iodide of potassium. With regard to the dose necessary, 
what is true of syphilis is equally true of the mineral poisons : in order 
to remove them, the organism must be saturated by the remedy. From 
fifteen grains to a drachm, three or four times a day, should be given ; 
but the measure of the quantity required is the effect produced. The 
iodides penetrate into every tissue, convert the deposited metal into 
soluble combinations, and cause them to be discharged by the various 
organs of excretion, chiefly by the kidneys. It has been repeatedly as- 
serted that salivation may be induced, and existing salivation increased, 
by the use of the iodides for the removal of mercurial salts from the or- 
ganism; but the author has not witnessed any facts which support this 
statement. 

In skin-diseases of syphilitic origin there can be no question as to 
the utility of the iodides. But these remedies are more especially cura- 
tive in the tertiary affections, especially in destructive syphilitic ulcera- 
tions. Hebra insists, and with justice, that the preparations of iodine 
are only useful in lupus, whether syphilitic or scrofulous, and do not 
permanently improve other cutaneous diseases. Mr. Hutchison calls 
attention to the fact that the various skin-diseases classed as hydroa 
may be produced by the iodide of potassium. The author has certainly 
had one case illustrating this action of the iodide. 

Local Uses op the Preparations of Iodine. — The tincture of 
iodine is in universal use as a counter-irritant. It is applied by means 



224 AGENTS INCREASING WASTE. 

of a camel's-hair brush to goitre, to enlarged glands, and to superficial 
inflammatory swellings before the formation of pus. Painted over the 
neck, it is a useful counter-irritant in acute affections of the pharynx 
and larynx, and to the chest to relieve the chest-pains which occur in 
phthisis. It is the most serviceable counter-irritant to promote absorp- 
tion of inflammatory products in catarrhal and fibrinous pneumonia 
after the acuter symptoms have subsided. The same application ap- 
pears to possess the power to promote the absorption of pleuritic effu- 
sion. It is a good plan in these affections to paint, on successive days, 
the tincture over the front, the lateral, and the posterior wall of the 
chest, so that one surface has time to recover from the irritation before 
it is again attacked. As the susceptibility to the action of the iodine 
varies in different subjects, it is always prudent to make a slight appli- 
cation in the beginning. If extreme burning follow the applications, 
the iodine may be dissolved off by a solution of iodide of potassium, by 
alcohol or ether. 

The tincture and the ointments of iodine are also used to remove the 
induration of the breasts which, results from attacks of inflammation. 
It must be remembered that the integument in this situation is ex- 
tremely sensitive to irritating applications. Splenic and hepatic disor- 
ders of a chronic kind are frequently treated locally by the application 
of tincture and ointment of iodine. Enlarged spleen of malarial origin 
is more speedily cured by the application of the official red iodide-of- 
mercury ointment, and, as regards hepatic disorders, the only affection 
which has seemed to the author to be beneBted by iodine applications 
is the engorgement due to malarial attacks. 

After the acute symptoms have subsided, tincture of iodine will re- 
move the swelling of orchitis. The scrotum, like the female breast, is 
very sensitive to the irritation of iodine-tincture and ointments. Hubo, 
like the enlarged lj-mphatic glands in other situations, may be treated 
by the application of iodine-tincture, but it is not very effective. 

Although Hebra does not approve of the internal use of iodine in 
cutaneous diseases, he advises the local application. He employs the 
tincture or glycerine solution in chloasma, lentigo, and lupus. The 
tincture of iodine is used to prevent the pitting of small-pox. Accord- 
ing to Piringer, it should be applied as follows : If on the first day of 
the eruption, the whole face, including the eyelids, is brushed over with 
the tinctnre of iodine ten times, there being an interval of a half-hour 
between each application ; if on the second day, twelve applications ; 
if on the third day, twelve to sixteen applications. The tincture of 
iodine is sometimes painted over the affected surface in erysipelas, and 
over the surrounding healthy integument, to prevent the spread of the 
disease, but, according to the author's experience, it is a bad practice. 

Iodoform may be substituted for iodine in the form of ointment 
i 3j— 3j — 3J). This may be used locally, rubbed in, as the iodine- 



IODINE AND IODIDES. 2g5 

ointments are, for the relief of local inflammatory swellings, enlarged 
lymphatic glands, goitre, etc. The strong, diffusive, and peculiar odor 
of iodoform is an objection to its use in this way. Iodoform powdered 
and dusted over the diseased surface is an excellent application to 
sloughing and ill-continued wounds, writable ulcers, rodent ulcer, chan- 
croid, sloughing phagedena, and serpiginous syphilitic ulcers. It allays 
pain, changes the morbid action, and is antiseptic. Syphilitic ulcers of 
the tonsils, pharynx, and tongue, are most effectually treated by local 
and direct application of powdered iodoform. In these cases the powder 
may be blown on to the surface of the ulcer by an insufflator or insuffla- 
tion-tube. Fissures of the anus, haemorrhoids, and ulcers of the rec- 
tum, are improved in condition, and the pain which attends them re- 
lieved by application of the ointment of iodoform and by iodoform sup- 
positories. The latter are also of undoubted service in chronic metritis 
and hypertrophy of the prostate when introduced into the rectum ; the 
iodoform diffuses into the neighboring organs, and' acts directly upon 
them. The pain of cancer may be somewhat relieved, and the fetid 
odor which attends the discharges may be removed, by the application 
of iodoform to the diseased surface. This treatment may be applied to 
cancer in any situation, but is especially applicable to cancer of the 
uterus and rectum. 

The parenchymatous injection of tincture of iodine is a remedial 
means of great importance. The method of employing it is exceed- 
ingly simple. An ordinary hypodermic syringe (glass or hard rubber) 
is charged with five to fifteen minims or more of the tincture, and the 
needle is thrust deeply into the affected tissue, and the iodine is slowly 
discharged. For injection into parts very deeply situated, long needles, 
such as are made for aspiration, can be used. This method of treat- 
ment is very effective in hypertrophied tonsils, goitre, glandular 
tumors, and the compound cystic and glandular growths so frequently 
found in the neck. The author has witnessed the cure of many 
cases of this kind by the parenchymatous injection of tincture of 
iodine. Some precautions must be attended to in practising these in- 
jections. "When the point of the needle is inserted as deeply as desired, 
it should be moved about to disengage it from any vessels into which 
it may have penetrated. The injection should be practised slowly, to 
give time for the tincture to diffuse into the substance of the tumor. It 
need hardly be remarked that the superficial vessels of the neck should 
be avoided in inserting the needle. 

When hydrothorax returns after evacuation of the cavity by the 
trocar, the compound solution of iodine or the tincture may be injected 
into the pleural sac. In empyema, the undiluted tincture of iodine 
may be thrown in without risk, and with great benefit. Ordinarily, 
a solution of the following strength may be used to wash out the cav- 
ity in cases of empyema : J>. Liq. iodinii comp., |\j ; aquse, 3 xv. M. 
16 



226 AGENTS INCREASING WASTE. 

Hydatids of the liver may easily be destroyed by injecting into 
them a few drops of tincture of iodine. It has, however, been shown 
that simple capillary puncture and withdrawal of the fluid suffice to 
arrest the growth and to abort these parasites. Injection of tincture 
•of iodine is one of the means resorted to to cure hydrocele. 

It is said that hypertrophied prostate may be diminished and further 
enlargement prevented by parenchymatous injection of iodine. In the 
performance of this operation a Sims or bivalve rectal speculum is in- 
serted, and the needle of the syringe is passed through the walls of the 
rectum into the gland. Careful palpation previous to the insertion of 
the needle will enable the operator to avoid important vessels. 

Unilocular ovarian cysts may sometimes be cured by injecting into 
them, after the withdrawal of the fluid, ten to sixteen ounces of tincture 
of iodine. No other form of ovarian cyst will, however, be affected 
favorably by this expedient. 

Large abscesses may be made to close much more speedily than they 
would otherwise, and septic infection be prevented, by the injection of 
iodine tincture after the evacuation of the matter. 

Numerous cases of spina bifida have been cured by the injection 
into the sac of tincture of iodine ( 3 ss) or a solution of iodine (gr. ss) 
and iodide of potassium (gr. v) in water ( 3 j). 

Iodo-Tannin. — This is an excellent application for local diseases. 
Tannin may be dissolved to saturation in tincture of iodine, or an aque- 
ous solution may be prepared as follows : r>. Iodinii, 3 j ; acid, tannici, 
§ j ; aquas, Oj. After filtration to be evaporated to § iv. 

The author has found a saturated solution of tannin in tincture of 
iodine a most efficient application in all those cases of uterine disease 
in which the tincture of iodine and iodized cotton and iodized glycerine 
are now so much used. It is serviceable in chronic cervicitis, chronic 
endo-metritis, sub-involution and hypertrophy of the uterus. The au- 
thor has also found that the following combination is a capital applica- 
tion in leucorrhoea and the above-named uterine affections : I£. Iodo- 
formi, 3 j ; acid, tannici, § j. M. Sig. A sufficient quantity to be packed 
in the dry state around the cervix. 

The iodide of starch is used by Mr. Marshall as a dressing for syphi- 
litic ulcers, and he speaks highly of its efficacy. 

A decolorized tincture of iodine for external use may be prepared 
as follows : iodine, hyposulphite of sodium, distilled water, of each ten 
parts. Dissolve with a moderate heat, and add sixteen parts of spirits 
ammonia, and, after a few minutes' agitation, add seventy-five parts of 
alcohol. The solution must stand in a cool place for three days, and 
then be filtered (Waldenburg und Simon). 

An extemporaneous iodo-tannin may be prepared according to the 
formula of Sigmund : fy . Tinct. iodinii, tinct. gallas, aa § ss. M. The 
strength of this may be increased by the addition of iodine 3ij. 



MERCURY. 227 

Authorities referred to : 

Bellini, of Florence, and Rf.ixzi, of Naples. Controversy on the Action of Iodine, 
reported in Union Medicate, No. 20, p. 481. 

Benedict, Dr. Moriz. Schmidt's Jahrbiichcr der gesammten Medicin, vol. cxv., p. 284. 

liisz, Prof. Dr. C. Archiv fur patholoyische Anatomie und Phys., Virchow's Archiv, 
Berlin, 1874, p. 124. 

Frankel, Dr. B. Berliner klinische Wochenschrift, ix., 6, 1872. 

Gubler, Dr. A. Commentaires Tfierapeutiques da Codex Med., pp. 412, 527. 

Hebra, Prof. Von. Ally. Wien. med. Zeitg., vii., 3, 1862. Schmidt's Jahrbiichcr, voL 
cxvii., p. 26. 

Hermann, Dr. Jos. Die Nichtexistenz des constitutionellen Iodismus, Schmidt's Jahr- 
bucher, vol. cxii., p. 19. 

Hutchison, Mr. Jonathan. Lancet, May 22, 1875, p. 725. 

Izard, Dr. A. A. Nouveau Traite de la Malad. Ven. et des Syph. Ulccreuses par 
Vlodoforme, Paris, 1871. 

Kammerer, Prof. Dr. Hermann. Archiv fur path. Anat. und Phys., von Rudolph 
Virchow, 1874, p. 459. The article of Binz, above referred to, was instigated by this 
paper. 

Raboteau, Dr. Gazette de Paris, 14, 1869. Schmidt's Jahrbucher, vol. cxliv., p. 28. 
Ibid., vol. cxlv., p. 272. 

Rosenthal, Prof. Dr. Zur Kenniniss dcr Resorption und Absorption der Iodpraparate, 
Wien. med. Woch., xiii., 1863. 

Schmidt, Dr. J. B. Berl. klin. Wochen., vii., 34, 1870. 

Trousseau et Pidoux. Traite de Therap. et de Mat. Med., vol. ii., huitieme edition. 

Waldenbcrg und Simon. Handbuch der ally, und spec. Arzneiverordnungs-Lehre, 
Berlin, 1873, pp. 397, 666. 

MERCURY AND ITS PREPARATIONS. 

Hyilrargyrum. — Mercury. Mercure, Fr. ; Quecksilber, Ger. A sil- 
ver-white metal, liquid at common temperatures, and having the specific 
gravity 13.5. It is wholly volatilized by heat, and is dissolved without 
residue by nitric acid. 

Preparations. — Emplastrum Ammoniaci cum Hydrargyro. — Plas- 
ter of ammoniac with mercury. Composition: Ammoniac, 12 ounces ; 
mercury, 3 ounces ; olive-oil, 60 grains ; sublimated sulphur, 8 grains. 

Emplastrum Hydrargyri. — Mercurial plaster. Composition : Mer- 
cury, 6 ounces ; olive-oil and resin ; of each, 2 troy-ounces ; lead-plaster, 
12 troy-ounces. 

Hydrargyrum cum Creta. — Mercury with chalk. Composition: 
Mercury, 3 troy-ounces ; prepared chalk, 5 troy-ounces. " A gray pow- 
der partly dissipated by heat. When a small portion is treated with di- 
lute acetic acid in excess, it is partly dissolved, nothing remaining but 
mercury in the form of minute globules, visible by the aid of a magnify- 
ing-glass." Dose, gr. ss — gr. x. Eight grains contain three grains of 
mercury. 

Pilulce Hydrargyri.— Pills of mercury. Blue mass. Composition : 
Mercury, confection of rose and liquorice-root powdered. Each three 
grains contains one grain of metallic mercury. Dose, gr. ss — g r . xv. 



228 • AGENTS INCREASING WASTE. 

Unguentum Hydrargyri. — Mercurial ointment. Composition : Mer 
cury, lard, and suet. 

Hydrargyri Oxidum Flavum. — Yellow oxide of mercury. "An 
orange-yellow powder, which, on being heated, assumes a red color ; 
then, if the heat be increased, it evolves oxygen, and finally the mercury 
evaporates without residue." 

Unguentum Hydrargyri Oxidi Flavi. — Ointment of yellow oxide of 
mercury. Composition : Yellow oxide, 60 grains ; ointment, 420 grains. 

Hydrargyri Oxidum Rubrum. — Red oxide of mercury. Red pre- 
cipitate. "An orange-red powder, entirely soluble in muriatic acid, 
When heated it does not emit reddish fumes, but gives off oxj'gen, 
while the mercury either runs into globules, or is wholly dissipated." 

Unguentum Hydrargyri Oxidi Rubri. — Ointment of red oxide of 
mercury. Composition : Red oxide, 60 grains ; ointment, 420 grains. 

Hydrargyri Sulphas Flava. — Yellow sulphate of mercury. Tur- 
peth mineral. " A lemon-yellow powder, sparingly soluble in water. 
It is entirely dissipated by heat, sulphurous acid being evolved, and 
globules of mercury sublimed. Dose, grs. ij — grs. v, as an emetic. 

Hydrargyri Chloridum Corrosivum. — Corrosive chloride of mer- 
cury. Corrosive sublimate. " In colorless crystals or crystalline masses, 
which are fusible, and sublime without residue. It is entirely soluble 
in water (1 in 15), alcohol (1 in 7), and ether. Lime-water causes a 
yellowish precipitate, and ammonia a white one, from its solution." 
Dose, gr. ^ — gr. ^ 

Hydrargyri Chloridum Mite. — Mild chloride of mercury. Calomel. 
"A white powder, wholly volatilized by heat, and insoluble in water, 
alcohol, and ether. With solution of potassa it yields a black precipi- 
tate of oxide of mercury, which is reduced by heat to the metallic state. 
Distilled water, after having been boiled with it, yields no precipitate 
with ammonia or nitrate of silver." Dose, gr. -Jg- — grs. x. 

Pilulm Antimonii Composito?. — Compound pills of antimony. 
Plummer's pills. Composition : Sulphurated antimony, calomel, and 
guaiac. Each pill contains one-half grain each of antimony and calomel, 
and one grain of guaiac. 

Hydrargyri Cyanidum. — Cyanide of mercury. " In white prismat- 
ic crystals, wholly soluble in water. When muriatic acid is added to 
the solution, hydrocyanic acid is evolved, made evident by its odor, and 
bichloride of mercury is left, which is entirely volatilized by heat. Dose, 

g r - A - S r - h 

Hydrargyrum Ammoniatum. — Ammoniated mercury. White pre- 
cipitate. "In white powder or pulverulent masses, decomposed and 
entirely dissipated by a strong heat, insoluble in water and alcohol, but 
dissolved without effervescence by muriatic acid." 

Unguentum Hydrargyri Ammoniati. — Ointment of ammoniated 
mercury. Composition: Ammoniated mercury, 3j; ointment, a troy- 
ounce. 



MERCURY. 229 

Hydrargyri Iodidum Viride. — Green iodide of mercury. "A 
greenish-yellow powder, which becomes red when heated. It is insolu- 
ble in water and alcohol." Dose, gr. -J — gr. j. 

Hydrargyri Iodidum JRubrum. — Red iodide of mercury. " A red 
powder, which becomes yellow when heated, and red again when cold. 
It is wholly volatilized by heat, condensing in scales, which are at first 
yellow, but afterward become red. It is insoluble in water, but is dis- 
solved by bailing alcohol, and by solutions of iodide of potassium and 
chloride of sodium." Dose, gr. ^ — gr. -fa 

Unguentum Hydrargyri Iodldl liubri. — Ointment of red iodide of 
mercury. Composition: Red iodide, 1G grains ; ointment, a troy-ounce. 

Hydrargyri Sulphuretum JRubrum. — Red sulphuret of mercury. 
Cinnabar. "In brilliant crystalline masses, of a deep-red color and 
fibrous texture. It is entirely volatilized by heat. When heated with 
potassa, it yields globules of mercury. It is not soluble in either nitric 
or muriatic acid, but is dissolved by a mixture of the two. Acetic acid 
which has been digested with it does not yield a precipitate with iodide 
of potassium." 

Liquor Hydrargyri Nitratis. — Solution of nitrate of mercury. Met 1 - 
cury dissolved in nitric acid. Acid nitrate of mercury. " A transpar- 
ent, nearly colorless, acid liquid, having the specific gravity 2.165. It 
is not precipitated by the addition of distilled water; and the diluted 
solution affords, with pctassa, a dirty-yellow precipitate, and with iodide 
of potassium a bright-red one, soluble in an excess of the precipitant. 
When dropped on a bright surface of copper, the diluted solution in- 
stantly deposits a coating of mercury." 

Unguentum Hydrargyri Nitratis. — Ointment of nitrate of mercury. 
Citrine ointment. 

Unguentum Hydrargyri Nitratis JRubrum. — Brown citrine oint- 
ment. Unofficial. This differs from the preceding and official citrine 
ointment, in being made with cod-liver oil. It is dark brown in color, 
mo7-e agreeable in odor, and more efficient as a remedy. 

Oleate of Mercury is an unofficial preparation for external use, con- 
sisting of a solution of oleate in oleic acid.' It is a liquid of the consist- 
ence of glycerine, or a soft solid. Applied to the skin by a brush, with- 
out friction, or with moderate friction, it produces the constitutional 
effect of mercury and very promptly. 

Antagonists and Incompatibles. — Corrosive sublimate is incom- 
patible with alkalies and their carbonates, lime-water, tartar emetic, ni- 
trate of silver, acetate of lead, albumen, iodide of potassium, soaps, vari- 
ous vegetable infusions, including cinchona. Calomel is incompatible 
with the alkalies, and alkaline earths and alkaline carbonates, with iron, 
lead, and copper. It should not be given in the same prescription with 
iodine (forms red iodide), and nitro-muriatic acid should not be pre- 
scribed in conjunction with it, lest corrosive sublimate be formed. 



230 AGENTS INCREASING WASTE. 

There is little doubt, also, that calomel is converted into corrosive sub- 
limate by the chlorides of sodium, potassium, and ammonium. The acids 
and acidulous salts are incompatible with hydrargyrum cum creta. 

In cases of poisoning by mercurial salts, especially corrosive subli- 
mate, albumen, white of egg, wheaten flour, milk, etc., may be adminis- 
tered. The white of one egg is considered sufficient for four grains of 
corrosive sublimate. An excess of albumen may redissolve the com- 
pound. Emesis should be promptly induced. 

Synergists. — Depressing medicines, antimony, alkalies, especially 
alkaline chlorides, etc., promote the physiological activity of mercurials. 

Physiological Actions. — Metallic mercury in direct contact with 
the skin or mucous membrane is without action. Swallowed, it is pur- 
gative by virtue of its weight. If retained in the intestinal canal, it 
will form soluble combinations, enter the blood, and produce character- 
istic systemic effects. Similarly prolonged contact with the skin will 
be followed by the constitutional action of the drug. Injected into the 
veins, it will be arrested in the capillaries, producing the usual phenom- 
ena of capillary embolism. Mercury gives off vapors at the ordinary 
temperatures, which have, in notable instances, caused serious constitu- 
tional symptoms. As used in the mechanical arts, by gilders and others, 
the fumes of mercury cause wasting, ptyalism, necrosis of bones, trem- 
bling, impaired intellect, and in women, abortion. Without producing 
such obvious effects as ptyalism, mercurial cachexia, eczema, and dis- 
ease of the bones, obscure nervous phenomena may result. Among 
these may be enumerated headache, loss of memory, trembling, defects 
of coordination, disorders of sensation, convulsions, and dementia. 

Mercury is readily absorbed — as a vapor by the pulmonary mucous 
membrane, when applied to the integument, or when taken into the ali- 
mentary canal. It probably exists in the blood as an albuminate. Re- 
cent experiments (Wilbouchewiez, Keyes) have shown that mercury, as 
iron, manganese, and other metals, has the power to increase the number 
of red corpuscles, and to improve the quality of the blood, provided it is 
exhibited in small quantities, not often repeated. It has long been known 
(Liegeois) that this result followed the use of corrosive chloride in syphi- 
lis. Schlesinger has recently gone over the question anew with the 
same result, but he doubts whether the effects are really tonic. It 
remains true, however, that any considerable quantity of mercmy, 
administered a sufficient time, wall affect the quality and composition 
of the blood ; the red globules are diminished in number ; the fibrine 
loses its plasticity ; the proportion of water is increased, and various 
effete materials, whose nature is unknown, accumulate. Mercury 
is deposited in all the textures, interferes with the normal nutritive 
processes, and is found in all the secretions and excretions. A 
marked degree of anaemia, loss of flesh, muscular weakness, intractable 
ulcerations of the skin, loss of hair, eczema, a f cul breath, diarrhoea, the 



MERCURY. 231 

stools being very fetid, are the characteristic symptoms of the action of 
mercur3' on the solids and fluids of the body. 

This metal has a selective action on the lymphatic glandular system, 
and notably on the salivary glands and pancreas. Among the earlier 
symptoms of the action of mercury are an increase of the salivary secre- 
tion, an alteration of its quality, fetor of the breath, swollen tongue, 
soreness of the teeth, a blue or dark slate-colored line along the margin 
of the teeth, sponginess of the gums, swelling of the parotid, sublingual, 
and submaxillary glands, aching of the jaws and teeth, with general 
muscular soreness and aching of the limbs, and some elevation of tem- 
perature. To this state are applied the terms acute mercurialismus, piy- 
alism, in common language, salivation. Mercury certainly stimulates 
the pancreas ; this gland, like the salivary glands, becomes swollen, con- 
gested, and pours out an abundant secretion which, however, is not a 
normal but a pathological secretion. There is little doubt also that 
mercury increases the action of the intestinal glandular appendages, 
and thus acts as a purgative. It not only increases the activity of these 
glands, but is itself in part excreted by them. The products of the in- 
creased waste of the tissues caused by mercury are also largely elimi- 
nated by the intestinal glands. These actions of mercury should not be 
regarded as a physiological stimulation of the intestinal glands, in the 
sense that the foods are stimulants to these organs. The action is 
pathological, and the products of the action are pathological. 

Mercury, like the metals in general, is excreted by the liver, and 
manifests a tendency to accumulate in this organ. Like the metals in 
general (iron, manganese, arsenic, copper, etc.), mercury doubtless acts 
as a stimulant to the hepatic cells, and increases their products. Just 
as an altered salivary or pancreatic fluid is produced by the action of 
mercury, so an altered or pathological bile is the result of the stimula- 
tion of the hepatic cells, by this metal. That its use increases the physi- 
ological and normal products of the liver seems an assumption hardly 
warranted by the facts which have now been accumulated. That mer 
cury (pil. hydrarg., calomel, hydrarg. cum creta), in purgative doses, 
increases the flow of bile into the intestine — is a cholagogue — cannot 
be successfully disputed ; but it is a cholagogue in the sense that cro- 
ton-oil and the resinous purgatives are : by irritation of the mucous 
membrane of the duodenum, it causes a reflex contraction of the gall- 
bladder and hepatic ducts, and an outflow of bile is the result. The 
presence of alimentary matters in the duodenum suffices to increase the 
production and discharge of bile ; purgatives, for the time being, some- 
what more energeticallj' produce the same result. A purgative dose of 
blue-pill, or calomel, may therefore cause bilious evacuations, but other 
purgatives may accomplish the same. Repeated stimulation of the liver 
by mercurials can only result in the production of an altered bile, and 
may, indeed, cause the organ to strike work, if too long persisted in 



232 AGENTS INCREASING WASTE. 

If we add to the cholagogue properties of mercury, which it possesses 
in common with resinous purgatives, the action on the pancreas and the 
increased elimination of the products of waste by the intestinal glands, 
we obtain a satisfactory explanation of those powers which have, under 
the term alterative, been heretofore ascribed to mercury. 

Mercury is eliminated by the salivary and the intestinal glands, by 
the liver, but chiefly by the kidneys. A small portion of the metal 
escapes by the skin also. The excretion of mercury is hastened and com- 
pleted by the iodide of potassium. As a result of the changes in the 
composition of the blood, and of the direct action of the metal on the 
renal epithelium, albuminuria is one of the symptoms present in cases 
of mercurialism. Without the use of special, means to render it solu- 
ble, and despite the use of such means, sometimes mercury remains 
permanently in the organism. When extremely severe cases of saliva- 
tion were not uncommon, permanent damage to the osseous structures 
often occurred, and globules of mercury could be shaken out of the dried 
bones of such subjects. Happily, nowadays, such cases do not oceur. 
The moderate use of mercury, short of ptyalism, does not appear to 
affect the human system injuriously. 

Effects of the Different Preparations. — Hydrargyrum cum 
oreta, calomel, and blue-pill are very similar in action. Calomel, being 
insoluble, probably escapes solution and combination in the stomach, 
and is decomposed by the alkaline contents of the small intestine, the 
oxide of mercury being precipitated. It follows, from this reaction, 
that the effects of blue-pill and calomel must be similar, and in practice 
it is found that they correspond closely therapeutically. Salivation 
more frequently results from the use of blue-pill than the other mercu- 
rials ; and calomel is next in point of activity in this respect. 

The corrosive chloride, the red iodide, and the cyanide, are powerful 
irritant and corrosive poisons. When a poisonous dose of corrosive 
sublimate has been swallowed, the mucous membrane of the mouth has 
usually, but not invariably, a whitish, glazed appearance, as if it had 
been washed over with a strong solution of the nitrate of silver. A 
sense of constriction of the throat and a strong styptic and metallic 
taste are experienced. The toxic symptoms follow in a few minutes 
the ingestion of the poison. Usually, violent pain is felt in the abdomen, 
but this is not invariable. Vomiting follows, and the vomited matter? 
consist at first of the contents of the stomach, and afterward of mucus 
streaked with blood. There are usually purging, tenesmus, intestinal 
cramp, and not unfrequently dysenteric discharges. These evidences 
of violent gastro-intestinal irritation are accompanied by small, weak 
pulse, coldness of the surface — but sometimes by a swollen and flushed 
face — sighing respiration, syncope, insensibility, or convulsions. If the 
patient survive a few days, ptyalism may occur. 

The following are the symptoms of chronic poisoning : abdorninai 



MERCURY. 233 

pains; nausea; vomiting; dysenteric diarrhoea; general weakness, 
trembling, or paralysis ; ptyalism ; fever; emaciation, etc. There some- 
times occurs a blue line along the margin of the teeth, not unlike that 
produced by lead. 

Suppression of urine is a not infrequent symptom in acute poison- 
ing, and albuminuria is very often present in cases of chronic mercuri- 
alismus. 

Therapy. — The acute glandular affections of throat and neck — ton- 
sillitis, parotitis, inflammation of the submaxillary and sublingual 
glands — are often speediky removed by mercurial preparations. The 
one-twentieth of a grain of calomel, the one-fifth of mercury with 
chalk, may be given every two hours, or one minim of the following 
solution may be administered at the same interval : I£. Ilydrarg. chlor. 
corrosiv., gr. j; aquae, 3 j. M. S. Dose, minim j. Chronic affec- 
tions of these organs are not benefited by these remedies, and the 
so-called scrofulous diseases of the cervical glands are made worse by 
them. 

Corrosive sublimate is an effective remedy in gastric ulcer. The 
thirtieth to the sixtieth of a grain, three times a day before meals, is a 
proper quantit}' and occasion for this purpose. Certain kinds of vomit- 
ing are quickly cured by small doses of calomel. The vomiting of 
children, caused by indigestible food, or by constipation, or by these 
causes combined, is often speedily relieved by one-twelfth-of-a-grain 
doses of calomel every half-hour or hour, dropped on the tongue. This 
remedy is the more efficacious when such vomiting is accompanied by 
great heat of head, restlessness, and fever. The vomiting of cholera 
infantum is often stopped by the same means. 

It has long been held that mercurials are specially indicated in that 
catarrhal state of the intestinal mucous membrane and of the hepatic 
duct, manifested by nausea, anorexia, tympanites, whitish or clay-col- 
ored stools, and jaundice. The use of mercury in these cases is predi- 
cated on its supposed power to promote the flow of bile. It is true, 
no doubt, that calomel and blue-pill will remove these symptoms, but 
such mild salines as phosphate of soda, sulphate of magnesia, tartrate 
of soda and potassa, etc., will usually succeed quite as well and without 
detriment. The diarrhoea and dysentery of infants (ileo-colitis) is 
frequently treated by minute doses of calomel or hydrargyrum cum 
creta. When there are much straining and bloody mucus, it is said 
that small doses of corrosive chloride prove very effective, but the 
author is convinced that mercurials are much abused in these affections. 
Children are quickly poisoned by mercurials, although they are not easily 
salivated. The spinach-colored stools which so frequently occur in 
the summer complaint of children, and which are, by ignorant prac- 
titioners, supposed to be produced by the mercury administered, really 
belong to cases of ileo-colitis, and may, by their persistence and pro- 



234 AGENTS INCREASING WASTE. 

fuseness, signify an increased irritation of the intestinal mucous mem- 
brane due to the remedies given. While the author believes that other 
medicines are more useful than mercury in the ileocolitis of children, 
he is convinced of the utility of minute doses of calomel (one-twenti- 
eth to one-twelfth of a grain every half-hour) when there is much irri- 
tability of the stomach. Mercurials are contraindicated in the diarrhoea 
and dysentery of adults. 

It was formerly an article of faith to hold that mercury was a sover- 
eign remedy in hepatic disorders. The state known as biliousness, 
characterized by a yellowish-coated tongue, yellow conjunctivas, muddy 
skin, nausea, constipation, may be removed by a mercurial purge when 
these symptoms are due to catarrh of the duodenum, excesses of the 
table, sudden checking of the perspiration, etc. The blue-pill, or mer- 
cury with chalk, or calomel, succeeds in these cases by removing offend- 
ing substances from the intestinal canal, by relieving a catarrhal state 
of the mucous membrane, or by causing elimination of waste products 
by the intestinal glandular apparatus. Less objectionable agents may 
be employed with equal success. 

The experience of the India medical officers has shown conclusively 
that mercurials are harmful in acute hepatitis, hepatic abscess, jaundice 
from gall-stones, acute yellow atrophy, etc. As these affections are 
very rife in India, an experience which has led to such conclusions 
should be heeded. There is no evidence to show that mercurials render 
the least service in cirrhosis. 

Calomel is a very efficient purgative. It will be retained when other 
purgatives are rejected by the stomach ; it is free from taste, and may 
therefore be given easily to children. When it operates, nausea and 
tormina may be experienced. One grain of calomel at night will act 
in the morning, and not unfrequently a half-grain will give satisfactory 
results. A full purgative dose of calomel (five grains) is an excellent 
vermifuge for the lumbricoid worms. It may be given with santonine. 
At the onset of acute- febrile diseases, calomel is a useful purgative ; it 
hastens waste, and causes the elimination of the products by the in- 
testine. 

Mercurials were formerly much esteemed in the treatment of acute 
inflammation, especially of serous membranes. As calomel, the mer- 
curial preparation usually employed, was combined with opium, it was 
not known to which remedy the good results were due, but the mer- 
curial was considered to have the larger share of merit. It is now 
admitted that opium was the effective agent. An apparent exception 
to this statement exists in the case of iritis, a disease in which the 
good effects of mercury are most conspicuous ; but iritis, probably, is 
always of syphilitic origin, and, in syphilitic inflammation of serous 
membranes, it is not disputed that mercurials are extremely efficacious. 
In these days, however, although opium is considered indispensable in 



MERCURY. 

peritonitis, pleuritis, pericarditis, etc., mercury is no longer combined 
with it. No longer is it considered necessary to "touch the gums" in 
order to cure a serous inflammation, and only the most prejudiced and 
benighted practitioners persist in the use of mercurials in these inflam- 
matory affections. 

Large doses of calomel — five grains every four hours — are said to be 
very efficacious in true croup or membranous laryngitis. It is claimed 
that it allays spasm and checks the formation of the false membrane. 
The author is skeptical in regard to the utility of calomel in this affec- 
tion. There is, however, no doubt as to the value of the yellow subsul- 
phate (turpeth mineral) as an emetic in this disease. If given early, 
so high an authority as Dr. Fordyce Barker, of Xew York, claims that 
a fatal result will most certainly be averted. From three to five grains 
of the subsulpbate may be given as an emetic for a child with croup. 
Serious results might be produced by this dose if emesis did not so 
promptly follow. The powder comes up with the contents of the stom- 
ach, in from five to fifteen minutes after being swallowed. But little 
depression follows the emesis produced by turpeth mineral, in which 
respect it has a decided advantage over sulphate of copper, tartar-emetic, 
and even ipecacuanha. As it is insoluble, this remedy should be rubbed 
up with sugar and placed on the base of the tongue. 

Liebermeister, following the lead of Traube, TTunderlich, and others, 
has obtained surprising results from the use of calomel in typhoid fever. 
By our German confreres this treatment is called the specific treatment 
of abdominal typhus. It consists in the administration of ten grains 
of calomel in a single dose the first day, and eight grains a day for three 
or four days thereafter. It is a curious fact that these large doses of 
calomel have an antipyretic effect. According to the statistics of Lie- 
bermeister, the " specific " calomel treatment shortens the duration and 
lessens the mortality from typhoid fever, as compared with the non- 
specific, expectant, or other plans of medication. 

Calomel is one of the numerous remedies used in the treatment of 
cholera Asiatic?. Two methods are pursued : large doses at consider- 
able intervals ; small doses frequently repeated. The latter method is 
nowadays much more usually practised. It consists in giving every 
fifteen minutes, half-hour, or hour, the one-sixth, one-half, or one grain 
of calomel, combined with opium, chalk, piperine, etc. The author, who 
has had considerable experience in the treatment of cholera, cannot ex- 
press any degree of confidence in the efficacy of this treatment. Large 
doses (a scruple to a drachm) sometimes appear to arrest vomiting 
when other means fail, but there is danger of excessive ptvalism when 
reaction sets in. 

The most important application of mercury, therapeutically, is in 
the treatment of syphilis. It may be regarded as specific in this dis- 
ease. The reaction which set in against its use a few vears asro has 



236 AGENTS INCREASING WASTE. 

certainly led to important modifications in the mode and quantity in 
which mercury should be given ; but the fact has been conclusively 
established that mercury, in a certain sense, is antidotal to syphilis. As 
mercury arrests the proliferation of the syphilitic virus in the blood, 
this agent should be used with the earliest manifestations of the specific 
character of the infecting sore. Mercury is not indicated in chancroid, 
or non-infecting chancre, and should not be used. If the chancre have 
the characteristic quality of the infecting sore, small doses of one of the 
mercurial preparations should be begun and continued steadily until 
all induration has disappeared. The important point is, not to induce 
ptyalisin. It is now conceded that the danger of a relapse will be very 
much lessened by continuing the mercurial treatment for some time after 
local manifestations have ceased. The ill effects of a mercurial course 
may be prevented by the use of small doses, by careful attention to hy- 
giene, and by lessening the dose, cr discontinuing the remedy entirely, 
whenever soreness of the jaws can be developed by smartly closing the 
teeth. By the adoption of these precautions, a mercurial course may 
be continued without important interruptions until the period of incu- 
bation has entirely passed. 

Various methods are resorted to for the introduction of mercury 
into the organism : 

1. Inunction. — Before practising inunction, the patient should take 
a warm bath, or, at least, wash the part to be operated on with soap 
and water. From fifteen to thirty grains of mercurial ointment is the 
quantity required for each inunction. The oleate of mercury in propor- 
tion of fifteen to thirty per cent, in the solution may be substituted for 
the ointment, but the oleate is to be applied with a brush, and not 
be rubbed in. Sigmund, the great advocate for the inunction method, 
has prescribed certain rules, which should be followed. The ointment 
should be rubbed in with moderate friction by the palm of the hand ; 
on the first day on the legs ; on the second day on the thighs ; on the 
third day on the abdomen and sides of the chest ; on the fourth day on 
the back ; on the fifth day on the arms. Mercurial inunctions are not 
borne equally well by all patients. Some are easily salivated, and 
others suffer from eczema or erythema. Moreover, the inunction treat- 
ment is filthy and troublesome, and it should, therefore, be restricted to 
those cases in which mercurials are badly borne by the stomach. 

2. Fumigation. — Various mercurial preparations may be used — the 
sulphuret, the iodide — but calomel is the best. The apparatus consists 
of a spirit-lamp, a plate to hold the calomel, surrounded by a shallow 
vessel containing water, a blanket large enough to cover the patient 
and the apparatus. The calomel is volatilized by the heat of the lamp, 
which, together with the vapor of water, is deposited on the skin of the 
patient. About fifteen minutes is the time required for the bath, and 
the quantity of calomel used ranges from eight to fifteen grains. The 



MERCURY. 237 

method of fumigation is especially adapted to cases of tertiary, with 
ulcerations, when the state of the patient is such as to forbid the inter- 
nal administration of mercurials. 

3. Hypodermic Method. — This consists in, the introduction under 
the skin of corrosive chloride, or calomel. R. Hydrarg. chlor. cor., gr. 
j j glycerini, 3 j ; aquae destil., 3 j. M. Sig. Ten minims a dose once 
a day. Tins method is cleanly, quick in results, and more successful 
than any other in preventing relapses. It has the disadvantages of 
giving great pain, and in frequently causing, troublesome abscesses and 
eschars. 

•i. Internal. — This method, in the nature of things, must be most fre- 
quently resorted to. Various mercurial preparations are used by differ- 
ent syphilographers. The Ricord school prefer the green iodide ; Sig- 
mund, mercurial-ointment inunctions ; Foerster, the yellow iodide ; 
Berkeley Hill, the red iodide ; Tilbury Fox, the cyanide ; Bumstead 
advises mercurial pill, the green iodide, the bichloride, according to cir- 
cumstances, but his preference is for the use of calomel by fumigation. 
That preparation of mercury is to be preferred which best agrees with 
the patient, is the rule. 

The indications for the use of iodine preparations have already been 
stated, but it may be useful, now, to place in juxtaposition the compara- 
tive utility of mercury and iodine : mercury for the primary infecting 
sore ; mercury for the affections of the skin, especially macular and 
papular exanthemata ; iodine for the tertiary symptoms : gummata ; 
tubercular syphilides ; serpiginous ulcers ; affections of the bones and 
periosteum, and nervous diseases. 

Hydrargyrum cum creta is usually preferred for the treatment of 
congenital syphilis. Mr. Marshall recommends the twenty-per-cent, 
ointment (the size of a pea) of the oleate of mercury, to be placed in 
the axilla night and morning for five or six days. 

Local Uses of Mercurials. — The acid nitrate of mercury is one of the 
best caustics for the destruction of chancroid. It should be applied 
with a glass rod after the surface of the sore has been ■well cleansed. 
It is now conceded that destruction of an infecting chancre does not 
prevent systemic infection. Syphilitic warts and vegetations on the 
genitals are amenable to the same treatment. Erosions and idcerated 
indurations are best treated by " black-wash" (calomel eight grains — 
lime-water, one ounce), or " yellow wash " (one grain of corrosive subli- 
mate to an ounce or two of lime-water). The surface of the sore may 
be kept wetted with these lotions. 

Ricord's treatment of condylomata consists in washing them with a 
solution of chlorinated soda, and then dusting them with calomel. Mer- 
curial applications are of very great service in cutaneous affections of 
syphilitic origin. A drachm of calomel to an ounce of lard makes an 
ointment which is very serviceable in herpes, psoriasis, and pruritics of 



238 AGENTS INCREASING WASTE. 

the vulva and anus. Ringer speaks of calomel-ointment in terms of 
great praise in various itching affections, especially of the anus and 
perinaeum. In acne, lotions containing corrosive sublimate, and oint 
ments of green and red iodide, are much employed: I£. Hydrarg, 
chlor. cor., 3j ; glycerini, 1 ss ; spts. vini rect., § vi j ; spts. rosmar. 
3 iv. M. For acne and pityriasis of the scalp: ]J. Hydrarg. iod 
virid., gr. x ; adipis, | j. M. R. Hydrarg. iod. rubri, gr. v; adipis, |j 
M. For acne indurata. The following is Startin's lotion of corrosive 
sublimate for syphilitic eruptions: Tfc. Hydrarg. chlor. cor., gr. iv 
acid, nitric, dil., 3 j ; acid, hydrocyan. dil., 3 j ; glycerini, 3 ij ; aquae, 
§ viij. M. For pityriasis, chloasma, etc. 

Lotions of corrosive sublimate are much employed in the treatment 
of parasitic skin-affections. The stronger ones must be used with cau- 
tion. It is rarely necessary to use a lotion stronger than two grains to 
the ounce. The following is an excellent formula of Tilbury Fox : R, . 
Hydrarg. chlor. cor., grs. iv ; alcohol, 3 vj ; ammoniae muriat., 3 ss ; 
aquae rosae, q. s. ad § vj. M. For scabies, ptheiriasis, and tinea versi- 
color. A scruple of corrosive sublimate to the ounce of simple oint- 
ment is an effective application in favus and tinea tonsurans, when 
used in the early stages of these affections. 

Calomel finely levigated and dusted over the membrane by means of 
a camel's-hair brush is an excellent local application in phlyctenular 
ophthalmia. Eczema of the margin of the eyelids is quickly cured by 
rubbing in every night, after detaching the scales, a small quantity of 
the brown citrine ointment. Chronic inflammation of the external au- 
ditory meatus is cured by the same application, viz., by allowing a 
small quantity of the brown citrine-ointment to remain in contact with 
the integument. 

Mr. Marshall strongly recommends the oleates in parasitic skin-dis- 
eases. He employs a five-per-cent. solution of oleate of mercury in oleic 
acid, adding an eighth part of ether. This is applied by means of a 
camel's-hair brush. It is used in sycosis, tinea, and chloasma, porrigo, 
pruritus ani, and pruritus pudendi. The oleates are extremely service- 
able remedies for the local treatment of syphilitic induration, but they 
are not advisable when ulceration exists. 

The oleate of mercury and morphia (obtained by the addition of the 
alkaloid morphia) is an elegant and efficient application in superficial 
inflammations, especially of joints of the rheumatic and arthritic varie- 
ties. Inflammatory indurations, left after the subsidence of acute trouble, 
are removed by the same combination. For application to these pur- 
poses Mr. Marshall employs a five-per-cent., ten-per-cent., and twenty- 
per-cent. solution of oleate of mercury in oleic acid. To every drachm 
of such solution he adds one grain of morphia. 

Mr. C. Bader, the eminent ophthalmologist of London, advises the 
following ointment in conjunctivitis: R. Hydrargyri oxidi rubri, 



GOLD. 239 

gr. x ; atropise sulph., gr. j ; vaselin., § j. M. Dr. Seely, of Cincin- 
nati, strongly urges the use of an ointment of the yellow oxide, eight 
or ten grains to the ounce of vaseline. He directs that the yellow 
oxide be triturated to the utmost degree of fineness, and then thor- 
oughly incorporated with the vaseline, the result being a bright-yellow 
ointment. A portion of this is taken on a probe, the lid lifted up, 
and the whole is wiped off on the mucous membrane. 

For pruritus of the vulva, the following lotion is recommended : 
Hydrarg. chlor. cor., one part ; alum, 20 parts ; starch, 100 parts ; and 
water, 2,500 parts. The official ointment of the red iodide of mercury 
is an effective application in simple hypertrophy of the thyroid gland, 
and an enlarged spleen, or ague-cake. A bit of ointment, the size of a 
large pea, is thoroughly rubbed in over the affected organ, the sun's 
rays falling on the part if practicable, or the friction may be carried 
on before a bright fire, or without. As soon as the skin becomes sore 
the applications are suspended until it recovers, when they may be re- 
sumed. The applications should be made daily. 

For that parasitic affection of the skin, p>ityriasis, there is no lotion 
so effective as a strong solution of corrosive sublimate — 3 j — 3 j — 
§ iv of rose-water. It need hardly be observed that these strong solu- 
tions require very careful handling. Less than necessary will fail, and 
application to an abraded surface will induce toxic symptoms. 

Aurum.— Gold. (Not official.) Or, Fr. ; Gold, Ger. 
Auri Chloridum. — Chloride of gold. Needle-shaped prisms of a 
beautiful yellow color, deliquescent, freely soluble in water. Dose, gr. 

sV— g r - tV 

Auri et Sodii Chloridum. — Chloride of gold and sodium. An or- 
ange-colored salt, crystallizing in four-sided prisms, soluble in water. 
Dose, gr. -^j—gr. tV- 

Antagonists and Incompatibles. — Eggs, albumen, milk, flour, are 
chemical antidotes. The contents of the stomach should, of course, be 
evacuated. The principles of treatment are the same as for poisoning 
by corrosive sublimate. 

Synergists. — The salts of mercury, especially the corrosive chloride, 
are very similar in action to the chlorides of gold, and are therefore syn- 
ergistic. 

Physiological Actions. — The chloride of gold is a caustic in its 
local action. In toxic dose it excites violent gastro-enteritis, accom- 
panied by such nervous phenomena as- cramps, convulsive trembling, in- 
somnia, priapism, insensibility, etc. In small medicinal doses these 
auric preparations promote the appetite and the digestive capacity. If 
long continued, especially if the dose be a full medicinal one, epigastric 
pain and distress are excited, nausea is induced, and loss of appetite 
follows. Constipation is usually produced by the preparations of gold, 



240 AGENTS INCREASING WASTE. 

and this, notwithstanding an increased secretion of the intestinal glandu- 
lar apparatus is one of the results of their administration. These prep- 
arations do not probably entirely enter the blood from the stomach, but 
part passes to the intestinal canal, is there decomposed, and is absorbed 
as oxide in combination with albumen. This is, however, conjectural. 
They are readily soluble and are very diffusible substances. What par- 
ticular influence they exert on the composition and function of the blood, 
is at present quite unknown. A form of fever, known as auric fever, is 
caused by their prolonged administration. This fever is accompanied 
by profuse sweats, a very abundant flow of urine, and increased salivary 
secretion. The salivation caused by the preparations of gold differs from 
the mercurial in that there is no tenderness nor ulceration of the gums. 

Peculiar effects on the mental state are produced by the administra- 
tion of the auric preparations. The functions of the mind become more 
active, and even excited, and a state of cheerfulness is induced. In men 
marked aphrodisiac effects are produced, and the erections are often 
painful ; in women increased venereal desires, and augmentation of the 
menstrual flow, are observed. 

The elimination of the auric preparations takes place by the liver, 
the intestinal canal, but chiefly by the kidneys. The urine assumes a 
bright yellow color. 

Prolonged administration of medicinal doses induces epigastric heat 
and oppression, headache, dryness of the throat and mouth, gastrointes- 
tinal irritation, fever. 

Therapy. — The chloride of gold and sodium in small doses (^ 
grain), three times a day, will relieve nervous dyspepsia. A red and 
glazed tongue, epigastric pain, increased by taking food, and a ten- 
dency to relaxation of the bowels after eating, are indications for the 
use of this salt. Catarrh of the duodenum, catarrh of the bile-ducts, 
jaundice, are symptoms which may usually be removed by the salts 
of gold. 

These preparations are employed chiefly in the treatment of syphilis, 
secondary and tertiary. They are indicated in the same cases in which 
corrosive sublimate is found effective. According to the author's ex- 
perience, they are especially adapted to old cases in which a protracted 
mercurial course and the large use of the iodide of potassium have 
failed to remove long-standing tertiary symptoms. He has found them 
very serviceable in recurring syphilitic ulcerations of the throat, syphi- 
litic ozozna, syphiloma of bones, syphilitic phthisis, etc. 

Amenorrhoea, dependent on torpor of the ovaries, may be removed 
by the persistent use of auric preparations. Chronic metritis, with 
scanty menstruation, is often remarkably benefited by them. Sterility ', 
dependent on these states, or due to coldness, is more certainly cured 
by these agents than by any other merely medicinal means. It is said 
by Martini that the tendency to habitual abortion may be averted by 



SILVER. 241 

the use of chloride of gold. This authority has also found that dropsy 
of the ovary may be sometimes cured by the same agent. 

Decline of the sexual power in man may be prevented by the use 
of gold salts, and the following are symptoms which may be removed 
sometimes by them : diurnal seminal losses, weak and inefficient erec- 
tions, inability for the sexual congress, due to irritability of the sexual 
organs. They increase the frequency of the nocturnal losses in those 
who are suffering from plethora of these organs. Cases that are bene- 
fited by the bromide of potassium are increased by the chloride of gold, 
and vice versa. 

The author calls especial attention to the use of the salts of gold in 
chronic Bright's disease, granular and fibroid kidney, and the so-called 
depurative disease. He has observed remarkable improvement to fol- 
low the persistent use of the chlorides of gold in these affections. They 
are best given in pill-form, and in small doses, -£$ — ■£$ of a grain 
three times a day. It need hardly be mentioned that these prepara- 
tions are not adapted to the acute forms of Bright's disease. 

Excellent results are obtained from the use of these auric prepara- 
tions in certain forms of mental disorder: e. g., melancholia, hypo- 
chondria, and allied mental states, accompanied by depression. Ver- 
tigo and vertiginous sensations, when due to stomach-disorders, are 
often removed by minute doses of the chlorides of gold, but plethora 
and increased intracranial blood-pressure contraindicate their use ; on 
the other hand, they have a high degree of utility when there is pres- 
ent the condition of cerebral anaemia. 

Authorities referred to : 

Gubler, Dr. Adolph. Commentaires du Codex Medicamenlarim, Paris, 1868, p. 506. 

Nothnagel, Dr. Hermann. Handbuchder Arzneimitidlehre, Berlin, 18*70, p. 310. 

Martini, Dr. Ludwig. Schmidt's Jahrbucher der gesamrnten Medicin, etc., vol. cxlvl, 
p. 263. 

Trousseau et Pidoux. Traite dc Therapeulique et de Matilre Medicate, huitieme edi- 
tion, vol. i., p. 388. 

Argentum. — Silver. Argent, Fr. ; Silber, Ger. 

Argenti Oxidum. — Oxide of silver. An olive-brown powder, very 
slightly soluble in water. Dose, gr. ss — grs. ij, in pill. 

Argenti N~itras. — Nitrate of silver. A heavy, colorless, anhydrous 
salt, wholly soluble in distilled water, and crystallizing in shining, rhom- 
bic plates. Dose, gr. \ — gr. ss, in pill, or in solution. 

Argenti JVitras Fusa. — Fused nitrate of silver. In cylindrical 
pieces. Is only used for topical applications. Mitigated nitrate con- 
tains two, three, three and one-half, and four, parts of nitrate of potassa 
to one of nitrate of silver. 

Argenti Cyanidum. — Cyanide of silver. Is a white powder, insol- 
uble in water. Dose : gr. -fa— -fa in pill form. 
17 



242 AGENTS INCREASING WASTE. 

Antagonists and Incompatibles. — The soluble chlorides and all 
substances containing them are incompatible with the nitrate of silver ; 
hence most of the natural waters decompose it, because they contain 
more or less common salt. An insoluble chloride of silver is the result 
of the decomposition. The following mineral acids, and their salts, are 
chemically incompatible : Sulphuric, muriatic, tartaric, and sulphurous. 
Alkalies and their carbonates, astringent infusions, and lime-water are 
incompatible. In cases of poisoning by nitrate of silver, common salt is 
the appropriate antidote. This should be given in solution very free!}', 
to act as an emetic as well as chemical antidote. 

Therapeutically the salts of silver are antagonized by all those agents 
which promote constructive metamorphosis. 

Synergists. — All agents promoting waste, as mercury, iodides, etc., 
favor the action, therapeutically, of nitrate of silver. 

Physiological Actions. — Nitrate of silver acts chemically on the 
tissues to which it is applied. It combines with the albumen, and ex- 
cites a superficial inflammation, producing in some subjects vesication, 
in all a whitish eschar. It is, therefore, an escharotic, but of very 
limited activity. The white eschar produced by it, subsequently — 
under the influence of light — becomes brownish-black. 

Nitrate of silver has a strong metallic, styptic taste. A strong solu- 
tion, brushed over the mucous membrane, whitens it. In the stomach, 
the salts of silver produce a sense of warmth at the epigastrium, and, in 
large (toxic) doses, excite a violent gastro-enteritis. Meeting in the 
stomach soluble chlorides, undoubtedly the insoluble chloride of silver 
is formed, but a portion of the salt, probably, at once enters into com- 
bination with albumen and peptones. That the action of nitrate of 
silver, when swallowed, is not that of the chloride has been experiment- 
ally shown ; hence the conversion of the nitrate salt into chloride does 
not suffice to explain the effects which ensue. Increased secretion 
from the intestinal glandular apparatus is produced by the silver salts, 
and the alvine dejections are softer and more frequent. Long-continued 
use of these agents will cause gastro-intestinal catarrh. 

The salts of silver most probably enter the blood as albuminates and 
peptonates. They effect very important changes in the blood, which 
becomes darker and more fluid, the red corpuscles paler and altered in 
outline, the haemoglobin convei'ted into hsematin. A slight lowering 
of the temperature is a result of these changes in the composition of 
the blood. Various tissues of the body undergo pathological altera- 
tions. The epithelium of the intestinal mucous membrane, of the 
kidneys and liver, becomes swollen and cloudy, and sometimes fatty. 
The amount of bile is increased, and albumen frequently appears 
in the urine. The nutrition of the body is impaired, and a progres- 
sive diminution in weight and strength takes place. The venous 
system is found in a state of stasis ; transudations take place, the 



SILVER. 243 

action of the heart is rapid and irregular, and the respiration is embar- 
rassed. 

The nervous system participates in the general impairment of struct- 
ure ; tetanic convulsions, paralysis, and insensibility, ensue. The pa- 
ralysis is not due to alterations in the muscular system — for the muscles 
preserve their irritability — but is centric in origin. It is true the mus- 
cles, in poisoning by silver, become granular and their stria; obliterated, 
but their contractility is not destroyed. 

Only a minute part of the silver administered is eliminated by the 
kidneys ; most of it escapes by the liver and the intestinal glands; but 
a portion remains permanently deposited in the tissues if its adminis- 
tration has been protracted. Rarely is it safe to continue the use of 
the preparations of silver longer than six weeks, and occasional purga- 
tives should be given to promote elimination. An olive, slate-colored, 
or grayish-brown discoloration of the various tissues of the body results 
from a deposition of silver. This is usually first seen at the margin of 
the teeth, or on the inside of the lips and cheeks, and is an indication 
that the system is becoming saturated. I find in Sieveking, " On Epi- 
leps}'," the following instructive instance of argyria : " The patient, a 
man aged sixty, became epileptic in March, 1856, and was treated with 
nitrate of silver almost from the commencement; for nine months he 
took a daily pill containing six grains, so that, during that time, he 
swallowed nearly three and a half ounces. Toward the end of July 
the skin began to be discolored, but, in spite of gastric symptoms, the 
remedy was persevered in. In 1857 haematemesis and other symptoms 
of gastric ulceration supervened, while the severity of the epilepsy had 
abated, and, having in the mean time come to England, he was admit- 
ted to the German Hospital, where he soon died. The special interest 
attaching to the autopsy is connected with the extent to which the sil- 
ver had been deposited in the tissues. The parts in the face which had 
exhibited the greatest intensity of discoloration, owing to their con- 
taining more blood, now pi'esented a tint uniform with the rest. In the 
brain the choroid plexuses presented a uniform grayish-blue tint. The 
lungs were tuberculous and pneumonic, the heart hypertrophic. The 
stomach contained a large quantity of acid, brown liquid streaked with 
blood, and at the upper part of the posterior wall was a large ulcer, at 
the base of which was an orifice blocked up by the adherent pancreas. 
The mucous membrane of the duodenum and jejunum was dotted over 
with many small black granules, most closely aggregated along the 
folds. In the ilium these spots become more and more scanty. . . . 
The spleen was small, its veins had an ashen hue, which was due to a 
finely-granular precipitate upon their coats. The liver was small, con- 
gested, and fatty ; the small branches of the vena portse, and of the 
hepatic veins, presented the same precipitate of silver throughout, but 
the capillaries were free from it. Fine sections of the hepatic tissue 



244 AGENTS INCREASING WASTE. 

showed numerous black dots, each of which occupied the centre of an 
acinus, corresponding to the point of exit of a central vein, and the 
color was produced by a black margin surrounding the calibre of the 
artery. The largest argentine deposit was in the kidneys. . . . The 
pyramids all exhibited a dark-gray color, which was deepest, and all but 
black, near the papillae. The tubules in these parts were entirely in- 
vested with a dense precipitate. . . . Parts of the skin taken from the 
temporal, axillary, and digital regions, were examined. Transverse sec- 
tions showed a pale, purplish streak immediately underneath the rete 
Malpighii, following the undulations of the cutis. . . . The glandular 
epithelium uniformly presented fatty degeneration." 

A persistent and long-continued use of the iodide of potassium and 
of the hyposulphite of soda has, in a few fortunate instances, caused 
the absorption and excretion of the silver deposits. The action of these 
systemic remedies for the discoloration may be aided by baths of the 
hyposulphites and by the cautious use of lotions containing the cyanide 
of potassium, which possess a decided solvent power over the silver 
deposits. 

Therapy. — The oxide and the nitrate of silver are extremely ser- 
viceable remedies in the so-called nervous dyspepsia, and in chronic 
gastric catarrh. They are indicated in the following state of things : 
Pain after taking food, lasting for an hour or more (gastralgia), the 
digestion, although slow, being good ; burning pain, with pyrosis, com- 
ing on after the completion of the stage of stomach digestion ; eructa- 
tions of food, with sour and acrid matters — the first being a gastralgia, 
and the other states being caused by gastric catarrh, and consequent 
fermentation of the starch, sugar, and fats. }>. Argenti oxidi, grs. v ; 
ext. hyoscyami, grs. v. M. ft. pil. no. x. Sig. One three times a day 
before meals. In chronic gastric catarrh, Frerichs recommends the fol- 
lowing formula: ]J. Argenti nitrat., grs. xv ; aq. destil., q. s. ; ext. 
belladonnse, grs. x; ol. caryophylli, gtt. x; rad. gentian pulv., ext. gen- 
tianse, aa q. s. ut ft. pil. no. lx. Sig. One pill three times a day. When 
there is much pain present, Wilson Fox highly commends the combina- 
tion of nitrate of silver and opium in chronic gastric catarrh, but, as 
constipation so frequently attends -this state, belladonna or hyoscyamus 
is usually to be preferred. Notwithstanding the strong opinion which 
Brinton has given adversely to the use of the salts of silver in ulcer of 
the stomach, the author agrees with Fox that these agents are, in this 
affection, next in value to bismuth. The oxide, or the nitrate, may be 
given in pill form, as above, or the nitrate in solution. In these stomach- 
affections, as a rule, the oxide of silver — being free from the causticity 
of the nitrate— is preferable. 

In jaundice dependent on catarrh of the biliary ducts, especially 
when there are present considerable pain and stomach-disorder, the 
salts of silver not only give relief to some of the more distressing 






SILVER. 24S 

symptoms, but assist materially in restoring the functional activity of 
the liver. As respects these hepatic disorders, silver has an action simi- 
lar to arsenic, manganese, mercury, and some other mineral remedies. 

Frequently nitrate of silver is remarkably beneficial in cholera in- 
fantum, after the acuter symptoms have subsided. The following is 
an excellent formula for a child a year old: r>. Argenti nitrat., gr. j; 
acid, nitric, dil., m. viij ; tinct. opii deod., m. viij ; mucil. acacite, 3 ss ; 
syrup, simplicis, 3 ss ; aquas cinnamomi, 3 j. M. Sig. A teaspoonful 
every three, four, or six hours. The nitrate of silver is also an efficient 
remedy in that form of diarrhoea in children in which the stools are 
white, pasty, and offensive, and the urine is high-colored and acrid. In 
dysentery, both of children and adults, after the acute symptoms have 
ceased, and in chronic dysentery, the nitrate of silver is a most efficient 
remedy. In some epidemics of acute dysentery, when the constitutional 
condition is one of depression, it is equally effective. In these maladies 
it is better to prescribe the nitrate in pill form (gr. \ — gr. j) combined 
with opium. With the stomach administration of the nitrate may be 
conjoined its local application to the rectal mucous membrane, and even 
in favorable instances to the descending colon. In using nitrate of 
silver by enema, the application, to be effective, should be made through 
a flexible tube passed cautiously to the sigmoid flexure or beyond. The 
bowel, previous to the introduction of the silver solution, should be as 
thoroughly washed out as possible by tepid water. From ten to twenty 
grains of the nitrate of silver, to a pint of water, is a suitable propor- 
tion for an enema. 

Obstinate dysenteric discharges, either alone or mixed with healthy- 
formed faeces, are not unfrequently caused by an idcer of the rectum. 
The most effective treatment for such an ulcer consists in the applica- 
tion to it, through a suitable speculum, of the solid stick of nitrate of 
silver. 

The author's experience justifies him in. asserting that the most effec- 
tive remedy for the diarrhoea of phthisis is nitrate of silver, combined 
with opium. When the diarrhoea of typhoid fever resists bismuth, 
Hope's mixture, and laudanum enemata, a satisfactory result may often 
be obtained by nitrate of silver, as follows : IJ. Argenti nitrat., grs. iij; 
pulv. opii, pulv. ipecac, aa grs. vj. M. ft. pil. no. xij. Sig. One every 
four or six hours. The nitrate of silver is one of the numerous reme- 
dies which have been used in the treatment of cholera. 

Formerly nitrate of silver was much employed in the treatment of 
epilepsy, but it has justly fallen into disuse, for, besides the danger of 
tinting the skin, it is not as effective as much less objectionable reme- 
dies. • Iodide of silver has proved very useful in the treatment of 
■whooping-cough, in the hands of Dr. Bell, of Glasgow. He gives one- 
eighth of a grain. Since proposed by Wunderlich, this agent has been 
fairly tested in the treatment of posterior spinal sclerosis (progressive 



246 AGENTS INCREASING WASTE. 

locomotor ataxia), and seems to have some influence in retarding the 
progress of the disease. 

Local Uses. — Nitrate of silver is largely used as an external appli- 
cation. A case has recently been reported in which argyriasis was pro- 
duced by the free application of this salt to the fauces, hence some care 
should be exercised in applying it to the mucous membranes. For external 
use, the cylinder and solutions of various strengths are employed. The 
" mitigated " stick is used chiefly by ophthalmologists. The most satis- 
factory solution for local application to the skin is obtained by dissolv- 
ing the salt in nitrous ether (grs. v — 3] — lj of ether). This solu- 
tion acts more energetically than the aqueous solution, and will readily 
vesicate. 

Solutions of nitrate of silver are much less frequently applied than 
formerly to inflamed tonsils, diphtheritic affections of fauces, acute 
laryngeal troubles, oedema of the glottis, etc. In the incipiency of 
tonsillitis, a strong solution (3j — 3j — 3J) may sometimes avert 
the attach, but if the inflammation be well established the irritant 
action of the caustic increases the morbid process. The most enlight- 
ened modern authorities (Oertel) condemn the use of caustics in diph- 
theria ; forcible detachment of the exudation only increases the chances 
of systemic infection, and injury done to the surrounding healthy mu- 
cous membrane invites the extension of the false membrane. A suffi- 
cient quantity of silver solution, to be effective, cannot be applied to the 
larynx, nor even to the aryteno-epiglottidean folds, without the aid of 
the mirror, and this manipulation is hardly available when a state of 
acute inflammation exists. Follicular pharyngitis is one of the affec- 
tions which can be successfully treated by systematic local applications 
of silver solution. Catarrh and idceration of the posterior nares may 
be cured by persistent use of the same remedy, the application being 
made by a suitable sponge probang, or brush, passed behind the veil 
of the palate. The appropriate strength for these purposes will depend, 
in part, on habit (grs. v — 3j — §j). Very weak solution of nitrate 
of silver (gr. j — §j) is sometimes used by the spray-douche (glass 
tube) in chronic inflammation of the pharynx, larynx, and trachea. 
Besides the ineffectiveness of this method, it is objectionable because the 
silver spray stains the face and clothing of the patient, unless a shield 
is very carefully used. To ulcers of the tonsils, tongue, syphilitic and 
otherwise, the solid nitrate is often used. It is a very painful applica- 
tion, and possesses but slight, if any, advantages over carbolic acid, 
which is anaesthetic after the first contact. 

A strong solution of nitrate of silver, especially in nitrous ether, is a 
most efficient application to check inflammation in superficial parts, 
e. g., boils, felon (paronychia), thecal abscess, orchitis, synovitis, etc. 
It is essential to the success of this treatment that the application be 
made early. According to the method of Mr. Furneaux Jordan, it is 



SILVER. 247 

better to make these applications to the adjacent " vascular territory," 
than to the inflamed part directly. To illustrate : In the case of orchi- 
tis, instead of painting the silver solution over the testicle, it is better 
to apply it along the groin and inner face of the thigh, over the course 
of the great vessels. 

Mr. Higginbottom, who is the author of this method of treatment, 
says that " we have no therapeutic agent so safe, powerful, or effica- 
cious, as the nitrate of silver in subduing external inflammation when 
properly applied. It has been invariably successful in my hands for 
nearly the last forty years." Such unstinted praise from so eminent 
an authority deserves our most respectful consideration. As the 
proper application of the remedy is so important, it were better to 
follow literally the method of Mr. Higginbottom : " The affected part 
should be well washed with soap-and-water, then with water alone, to 
remove every particle of soap, as the soap would decompose the nitrate 
of silver; then to be wiped dry with a soft towel. The concentrated 
solution of four scruples of the nitrate of silver to four drachms of dis- 
tilled water is then to be applied tico or three times on the inflamed sur- 
face and beyond it, on the healthy skin, to the extent of two or three 
inches. The solution may be applied with a small piece of clean linen, 
attached to the end of a short stick ; the linen to be renewed at each 
subsequent application. ... In about twelve hours it will be seen 
whether the solution has been well applied. If any inflamed part be 
unaffected, the solution must be immediately reapplied." 

The method of Mr. Higginbottom is extremely effective in traumatic 
erysipelas. The common facial erysipelas rarely requires anything but 
the simplest application. The concentrated solution of nitrate of silver 
should be thoroughly applied to malignant carbuncle of the lip, and to 
the adjacent healthy skin for a short distance. The pitting of small- 
pox may be prevented by rupturing each pustule and inserting into it a 
sharply-pointed pencil of the nitrate of silver. According to Mr. Hig- 
ginbottom, the same result may be accomplished, and with greatly less 
labor, by applying his solution in the manner above indicated. 

The solution of nitrate of silver in nitric ether (3ij — 3 j) is recom- 
mended by Fox in the chronic forms of erythema, eczema, psoriasis, and 
ringioorms. Indolent ulcers, discharging sores with flabby granula- 
tions, are improved in character, and made to heal by application of 
Higginbottom's concentrated solution, or of solid caustic. 

Ulceration of the cervix uteri, endo-cervicitis, granular cervicitis, 
endo-metritis, are effectively treated by nitrate-of-silver applications. 
The solid caustic may be quickly brushed over the mucous membrane, 
or a concentrated solution may be applied with a suitable "applicator." 
There is no doubt that solid caustic may be applied with safety in 
chronic cases to the interior of the uterine cavity, after preliminary dila- 
tation of the cervical canal. This is a most effective treatment, but in- 



248 AGENTS INCREASING WASTE. 

jury is often done by over-stimulation and too-prolonged contact of the 
caustic. Induration of the cervix and narrowing of the cervical canal 
are sometimes produced by injudicious use of the solid caustic. That 
troublesome affection, pruritus of the vulva, may often be removed, 
even when due to pregnancy, by washing the neck, and the cervical 
canal so far as it is accessible, with a strong solution of the nitrate of 
silver (3j — 3 j). When the pruritus is due to a vesicular eruption on 
the genitals, the application should be made to the affected part. Gon- 
orrhoea (vaginal) of the female is most quickly removed by applying 
through the speculum, and to every part of the canal, a concentrated 
solution of silver nitrate (3 j — 3 j). In the male, gonorrhoea, at its first 
appearance, may sometimes be aborted by a strong injection ( 3 j — § j), 
but unfortunately the period is usually past when this violent practice 
may be advised. Weak solutions (gr. j — grs. v — § j) are, as a rule, 
more efficient, as they are unquestionably safer. Cauterization of the 
prostatic part of the urethra was at one time vulgarized in the treat- 
ment of spermatorrhoea by the influence of Lallemand, but this danger- 
ous practice is rarely necessary. The author coincides with Mr. Fur- 
neaux Jordan in the expression of the belief that a vesicating solution of 
nitrate of silver applied to the perinagum is as generally useful, and, of 
course, entirely without danger. 

Solutions of nitrate of silver are much used in ophthalmic and aural 
surgery. To granular lids, a strong solution (3j — 3 j) is applied; to 
acute conjunctivitis, a weak solution (gr. j — grs. iv — § j) ; but gen- 
erally ophthalmologists prefer the zinc and copper salts in the treat- 
ment of these affections. The incautious use of silver salts, when there 
are corneal ulcers, may result in unsightly deposits and opacities. Otor- 
rhcea, eczema of the external auditory meatus, and chronic inflamma- 
tion of the external ear, may be cured by silver solutions properly ap- 
plied. A commencing furuncle of the external canal may sometimes be 
aborted by application of Mr. Higginbottom's solution. 

The stains made by nitrate of silver on fabrics or on the hands may 
be removed as follows : Moisten the spots and drop upon them a few 
drops of tincture of iodine, and wash with a solution ©f hyposulphite of 
soda ( 3 ss — § j). These stains may also be removed by washing them 
with the following solution : Cyanide of potassium, 3 ijss ; iodine, grs. 
xv ; water, §iij. 

Besides the above-mentioned external applications of nitrate of silver, 
this salt is also used according to the method of Luton, entitled " paren- 
chymatous substitution." This consists in injecting, with an hypodermic 
syringe, a few drops of a concentrated solution into the parenchyma of 
organs — an irritant injection. Cystic tumors (wens), small fatty tu- 
mors, abscesses, and hydrocele, may be cured by injecting five to ten 
drops of a strong solution (3 j — 3 ij). In the case of cysts and hydro- 
cele, the contents may be allowed to escape through the needle, and 



COPPER. 249 

then the irritant solution be injected. More or less active inflammation 
follows, and the sac, after a variable stage of suppuration, becomes en- 
tirely obliterated. 

Old and intractable cases of sciatica that resist other means, includ- 
ing hypodermic injection of anodynes, are sometimes permanently re- 
lieved by injecting deeply into the neighborhood of the affected nerve 
ten to twenty drops of a solution of nitrate of silver. Suppuration usu- 
ally follows, and the local inflammatory process terminates the previous- 
ly-existing nerve-lesion (parenchymatous substitution). 

Authorities referred to : 

Bartholow, Dr. Roberts. Manual of Hypodermic Medication, third edition, article, 
Irritant Injections. 

Booolowskt, Dr. Virchow's Archiv fiXr pathologkclie Analomie, vol. xlvi., 18G9, p. 409. 

Fox, Dr. Tilbury. On Diseases of the Skin, second edition, 1873. 

Fox, Dr. Wilson. On, Diseases of the Stomach, revised edition, London and New 
York, 1872, pp. 93, 142, 179. 

Higginbottom, John, F. R. S. The Practitioner, vol. ii., p. 34. 

Jordan, Fcrxeaux. The Practitioner, vol ii., p. 74. 

Reynolds, Dr. Rdssell. On Epilepsy, London, 1861, p. 333. 

Sievekino, Dr. Edward H. On Epilepsy, second edition, London, 1S61. 

Scattergood, Dr. Thomas. British Medical Journal, May 20, 1871. 

United States Dispensatory, thirteenth edition. 

(Juprum. — Copper. Cuivre, Fr. ; Kupfer, Ger. 

Cupri Subacetas. — Subacetate of copper. Verdigris. " In masses 
of a pale-green color, almost wholly soluble in dilute sulphuric acid, 
with the aid of heat. Ammonia added to the solution produces a pre- 
cipitate, which is entirely dissolved by an excess of the alkali." 

Cupri Sulphas. — Sulphate of copper. Blue vitriol. " In blue crys- 
tals, slightly efflorescent in the air, and entirely soluble in water. Am- 
monia throws down from the solution a precipitate, which is wholly 
dissolved when the alkali is added in excess." Dose, gr. ■£ — gr. ss. 

Cuprum Ammoniatum. — Ammoniated copper. A deep, azure-blue 
powder, having an ammoniacal odor, and a styptic, metallic taste. It is 
soluble in water. Dose, gr. ^ — gr. j. 

Aktagoxists and Ltcoatpatlbles. — Alkalies and their carbonates, 
lime-water, mineral salts (except the sulphates), iodides, and most 
astringent vegetables, are chemically incompatible with the salts of 
copper. In cases of poisoning, white of eggs and milk should be given 
freely, but evacuation of the contents of the stomach is necessan-, for 
the albuminate of copper is not devoid of toxic power. The most effec- 
tive chemical antidote is said to be the ferro-cyanide of potassium, form- 
ing the insoluble ferro-cyanide of copper. Magnesia has also been pro- 
posed, but it should not be relied on to the exclusion of albumen and 
ferro-cyanide of potassium, nor should any antidote be used without 
evacuating the stomach contents by emetics or the stomach-pump. 



250 AGENTS INCREASING WASTE. 

Synergists. — The salts of lead, tin, zinc, mercury, silver, gold, favor 
the therapeutic action of the copper-salts. All of these agents agree 
in this : they promote waste, and affect the functions of the nervous 
sj'stem secondarily. All unfavorable hygienic conditions, which de- 
press the functions of the body, increase the activity of the copper- 
salts. 

Physiological Actions. — The salts of copper have a styptic, metal- 
lic taste. When a poisonous dose of a copper-salt has been taken the 
following sj-mptoms, referable to the digestive organs, appear : A strong 
metallic taste, burning and constriction of the throat, increased flow of 
saliva, burning pain at the epigastrium, with griping and colic-pain of 
the intestines, nausea and vomiting. The vomited matters have usually 
a bluish or greenish color, and the intestinal evacuations, which begin 
in a few minutes after the poison has been swallowed, are dark-greenish 
and frequently bloody. These are the symptoms produced by the irri- 
tant poisons, and have no special characters, except, it may be, the color 
of the evacuations. The salts of copper, being diffusible substances, 
quickly enter the blood, and the systemic symptoms which follow are 
referable to the nervous system and the organs of excretion. In the 
blood, as is the case with the other metallic poisons, copper probably 
exists in the form of an albuminate in close relation to the red blood- 
globules. The breathing becomes short, hurried, and labored; the 
pulse small, quick, and weak; the skin cold and perspiring, and rest- 
lessness, headache, trembling, cramps, vertigo, and stupor, are followed 
by convulsions (clonic or tetanic), paralysis, and insensibilhVy. 

Inhalation of cupreous fumes, as in certain occupations in the arts, 
the slow introduction of small quantities, as occurs sometimes from 
cooking acid fruits in copper vessels, or the prolonged medicinal admin- 
istration of moderate doses of a copper-salt, will produce the symptoms 
of chronic or slow poisoning. When inhaled, the symptoms first ob- 
served are those of bronchial irritation and bronchial catarrh (Hirt). 
Internally administered, a gastro-intestinal catarrh is produced, epigas- 
tric pain is experienced, nausea, vomiting, colic, tenesmus, and dysen- 
teric discharges, and complete anorexia occur. The loss of appetite, 
and the interference- with digestion, as well as the injury done to the 
red blood-globules, impair the strength and increase the waste of the 
tissues. A purplish line along the margin of the gum has been ob- 
served, salivation and ulceration of the gums not unfrequently occur, 
and occasionally jaundice is present as one of the symptoms. As re- 
gards the nervous system, headache, muscular trembling, paresis of the 
limbs, and sometimes paralysis, altered sensations, defects of coordi- 
nation, impaired mind, result. These nervous symptoms, with bronchial 
and gastro-intestinal catarrh, are usually grouped together in the case 
of chronic cupreous poisoning in artisans. 

Copper is eliminated by the liver, intestinal canal, salivary glands, 



COPPER. 2g J 

and kidneys. As is the case with the other metallic poisons, copper 
tends to accumulate in the liver. 

Theuapy. — The sulphate of copper is one of the remedies sometimes 
effective in the vomiting of pregnancy. For this purpose not more 
than one-twentieth of a grain, three times a day, is admissible. IJ. 
Cupri sulphat., grs. ij ; aquae destil., 3 ss. M. Sig. Six drops a dose. 

As sulphate of copper is a very prompt and effective emetic, it is 
frequently resorted to in cases of narcotic poisoning. IJ . Cupri sul- 
phat., grs. vi; aquae destil., 3 ij. M. Sig. A tablespoonful every fifteen 
minutes until vomiting e?isue. It may be used under the same circum- 
stances, but is by no means so desirable an emetic, in croup, as subsul- 
phate of mercury. Minute doses of sulphate of copper render excellent 
service in g astro-intestinal catarrh, especially when the bowels are re- 
laxed. IJ. Cupri sulphat., gr. j ; ext. nucis vom., grs. iv. M. ft. pil. 
no. xvj. One three times a day before meals. When the food taken 
gives rise to colic, which is quickly followed by the inclination to stool, 
there should be combined with the above prescription one grain of 
morphium sulphate. When constipation coexists with intestinal catarrh, 
the following prescription is useful: IJ. Cupri sulphat., gr. j; ext. 
physotigmae, ext. belladonna?, ext. nucis vom., aa, grs. iv. Ft. pil. no. 
xvj. Sig. One pill, three times a day, before meals. 

The sulphate of copper is a most useful remedy in acute dysentery. 
]J. Cupri sulph., gr. ss; magnesia? sulph., §j; acid sulph. dil., 3j; 
aquae, 3 iv. M. Sig. A tablespoonful every four hours. After the 
acuter symptoms have subsided, the sulphate of copper may be given 
with morphia and opium. Of all the metallic astringents employed for 
this purpose, sulphate of copper is the most effective in chronic diar- 
rhoea and chronic dysentery. IJ. Cupri sulphat., gr. j ; morphias sulph. 
gr. j ; quinise sulph., grs. xxiv. M. ft. pil. no. xij. Sig. One pill three 
times a day. Sulphate of copper is indicated when there are present 
colic-pains, tenesmus, and the stools, j^artly feculent, contain mucus 
streaked with blood. When tolerance is established, the quantity of 
copper in the above formulae may be increased slowly to one-fourth of a 
grain. Rarely can more than one-twelfth of a grain be given to an adult 
unaccustomed to its use, without causing very unpleasant nausea and 
depression. 

The dysentery and cholera infantum of children, and the chronic 
entero-colitis which sometimes succeeds to measles, are often remark- 
ably benefited by minute doses of sulphate of copper. IJ. Cupri suhphat., 
gr. j ; tinct. opii deodor., gtt. viij ; aquae destil., I iv. M. Sig. A tea- 
spoonful every two, three, or four hours, for a child from one to two 
years of age. 

The sulphate of copper is a useful palliative astringent in the diar- 
rhoea of phthisis. It should be combined with opium. 

Kissel regards the salts of copper as curative in imeumonia, and the 



252 AGENTS INCREASING WASTE. 

preparation which he prefers is the tincture of the acetate (Phar. Ger.). 
The mortality under this treatment was only 4.3 per cent. Ammoni- 
ated copper has been used recently with remarkable success in the 
treatment of facial neuralgia. It must be pushed (Fereol). 

The salts of copper, especially the cicprwn ammoniatum, are among 
the numerous remedies employed in the treatment of epilepsy, chorea, 
and hysteria. Successful results have, it is true, been obtained by the 
use of these remedies, but at the present time they are rarely employed. 

External Uses. — The salts of copper do not act very energetically 
on the unbroken integument. Applied to wounds they are astringent 
— that is, they combine with albumen, contract the tissues, and coagu- 
late the blood. A crystal of sulphate of copper may be used to arrest 
bleeding from small wounds, e. g., from leech-bites. Indolent ulcers 
with flabby granulations can be stimulated to a renewed and more 
healthy activity by touching the affected surface with a crystal of sul- 
phate of copper, or by frequent application of a solution (grs. ij — grs. 
x — §j). The following is an excellent injection in gonorrhoea after 
the acute stage: r). Cupri sulph., grs. iv; morphiae sulph., grs. viij ; 
liq. plumbi subacetat., 3 j ; aquas rosas, § iv. M. Sig. As an injec- 
tion. In that troublesome affection granular lids, the sulphate of 
copper may be rubbed over the everted lid once a day with advan- 
tage. The application gives great pain, and is immediately followed 
by intense hyperemia, which, however, subsides in a few hours, leaving 
the conjunctiva in much better condition than before. 

In scabies, a solution of sulphate of copper ( | j — Oj) has been used 
with great success, the lotion being applied after the crusts have been 
thoroughly removed with soap and water. An ointment of acetate of 
copper (grs. x — |j) is a very effective application in herpes circinatus 
(ringworm). The following formula has been recommended in menta- 
gra: tjL Cupri sulph., 3j; zinci sulph., | ss ; aquas laur.-cerasi, |jss; 
aquae destil. ad § xvj. M. Sig. Lotion. The acetate and carbonate 
of copper are very effective remedies in tinea sycosis. IJ Cupri carb., 
3 ij ; adipis, f j. M. 

Authorities referred to : 

Hiet, Dr. LumviG. Die Krankhaften der Arbeiter, erste Abtheilung, p. 79, et seq., 
Breslau, 1871. 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic, Berlin, 1874, p. 209. 

Gubler, Prof. Adolph. Commcntaires Therapeutiqv.es du Codex Mcdicamentarius, 
Paris, 1S68, p. 435. 

Nothnagel, Dr. Hermann. Handbuch der Arzncimittellehre, Berlin, 1870, p. 291. 

Tardied, Ambroise. Diclionnaire cPHygiene Publique et de Salubrite, deux, edition, 
Paris, 1862, vol i., article Cuivre. 

Taylor, Dr. A. S. On Poisons, p. 4f>8, et seq. 

United States Dispensatory, thirteenth edition, articles Cuprum, Cupri Su/phas, 
Cupri Acetas. 



LEAD. 253 

Plumbum. — Lead. Plomb, Fr. ; Plei, Ger. 

Plumbi Oxidum. — Oxide of load. Litharge. " In small yellowish 
or orange-colored scales, insoluble in water, but almost wholly soluble, 
with slight effervescence, in dilute nitric acid. The solution is affected 
by potassa, like that of carbonate of lead in the same acid." 

JEmplastrum Plumbi. — Lead-plaster. Litharge and olive oil. 

Plumbi Acetas. — Acetate of lead. Sugar of lead. "In colorless 
crystals which effloresce on exposure to the air. It is dissolved by dis- 
tilled water, with a slight turbidness, which is removed by the addition 
of vinegar. With this solution carbonate of sodium produces a white, 
iodide of potassium a yellow, and hydrosulphuric acid a black precipi- 
tate. Upon the addition of sulphuric acid vapor is evolved, having the 
smell of vinegar." Dose, gr. ss — grs. v. 

Liquor Plumbi Subacetatis. — Solution of subacetate of lead. " A 
colorless liquid of the specific gravity of 1.267. It is decomposed by 
exposure to the air, carbonate of lead being formed. When added to a 
solution of gum it occasions a dense white precipitate." 

Liquor Plumbi Subacetatis Dilutus. — Diluted solution of subacetate 
of lead. (Solution of subacetate, 3iij; distilled water, Oj.) 

Ceratum Plumbi Subacetatis. — Cerate of subacetate of lead. 

Plumbi Carbonas. — Carbonate of lead. "A white substance in 
powder or pulverulent masses, insoluble in water, but soluble, with ef- 
fervescence, in dilute nitric acid. Potassa added to the solution pro- 
duces a white precipitate, which is wholly dissolved by an excess of the 
alkali. Heat renders it yellow, and, with the aid of charcoal, reduces 
it to the metallic state." 

TJnguentum Plumbi Carbonatis. — Ointment of carbonate of lead. 
(Carbonate, 3 j ; ointment, 3 vij.) 

Plumbi Nitras. — Nitrate of lead. " In white, nearly opaque, octa- 
hedral crystals, permanent in the air, and of a sweet astringent taste. 
It is soluble in seven and a half parts of cold water, and in alcohol. Its 
solution is precipitated black by hydrosulphate of ammonium, white by 
ferrocyanide of potassium, and yellow by iodide of potassium." 

Plumbi Iodidum. — Iodide of lead. "A bright-yellow, heavy, in- 
odorous powder, fusible and volatilizable by heat, and soluble in twelve 
hundred and thirty-five parts of cold, and one hundred and ninety-four 
parts of boiling water. A hot saturated solution, on cooling, deposits 
the salt in brilliant, golden scales." 

TJnguentum Plumbi Iodidi. — Ointment of iodide of lead. (Iodide 
of lead, 3 j ; ointment, 3 vij.) 

Antagonists and Incohpatibles. — Natural waters containing lime, 
sulphates, carbonates, carbonic acid, mineral acids and mineral salts, 
vegetable acids, alkalies, iodide of potassium, the vegetable astringents 
in general, albuminous solutions, and the preparations of opium, are in- 
compatible. In cases of poisoning by acetate of lead, the proper anti- 



254 AGENTS INCREASING WASTE. 

dotes are the sulphates of soda or magnesia, phosphate of soda, milk, 
and albuminous solutions. Emetics and the stomach-pump should be 
used. 

Synergists. — Cold, digitalis, ergot, veratrum viride, and agents act- 
ing similarly, favor the influence of acetate of lead over the circulatory 
system. Copper, mercury, antimony, and remedies promoting waste, 
increase the depressing effects of lead on the nutrition of the body. 

Physiological Actions. — The acetate is astringent ; that is, it 
combines with albumen to form compounds, for the most part insoluble 
in water and in acids. All the salts of lead are more or less toxic. As 
the acetate, which is most frequently the preparation taken, has a 
sweetish taste, mistakes not unfrequently happen ; but the after-taste 
is decidedly astringent and slightly metallic. As the combination of 
the salts of lead with albumen takes place on contact, this action ensues 
in the mouth in part, and is completed in the stomach. Any part of 
the lead reaching the intestinal canal must be converted into the insol- 
uble sulphide. A very large quantity of the acetate of lead is required 
to produce a fatal effect ; not less than an ounce. When swallowed in 
this quantity and retained, it produces intense gastric irritation, some- 
times cholerif orm symptoms, numbness, paralysis, coma, collapse. Owing 
to the fact that so large a quantity of acetate of lead will be rejected 
by vomiting, cases of acute poispning rarely terminate fatally, and are 
infrequent. On the other hand, chronic poisoning by lead is very com- 
mon, owing to the use of cosmetics and hair-dyes containing lead, the 
use of food preserved in tin cans soldered with lead, and to the con- 
tamination of drinking water. Very rarely is the acetate of lead so 
persistently used in medical practice as to produce toxic symptoms. 

When lead is slowly introduced into the organism in small doses, 
the first symptoms usually observed are loss of appetite, failure of 
strength, more or less wasting, paleness of the face and of the integu- 
ment generally, and constipation. The joints become the seat of rheu- 
matoid pain ; there is dry colic, the pain of which is assuaged by press- 
ure ; and the muscles of the abdominal parietes are also seized with 
neuralgia. At the same time the liver diminishes in size, the abdominal 
fat disappears, the intestines are contracted, the belly is drawn in 
toward the spinal column. Coincidently with the contraction of the 
liver, the skin assumes an icteroid hue, the conjunctivae become yellow, 
and the urine is tinged with the biliary coloring matters. At this time 
may be observed the so-called " blue line " along the margin of the 
incisor teeth — a slate-colored line, probably due to a deposition of the 
sulphide of lead, and found only, according to the author's experience, 
in those not accustomed to the use of a tooth-brush. The mucous 
membrane of the lips and mouth has often a bluish or slate-colored tint, 
and sometimes brownish pigment-deposits are seen on the lips near the 
teeth, and on the gums. Albuminuria may exist at this time, but it is 



LEAD. 255 

commonly present further on in the history of these cases. Lead may 
cause that condition of hyperalbuminosis which eventuates in albuminous 
urine, but probably it in most cases hastens the development of changes 
in the kidneys already impending. As Garrod has conclusively shown, 
the use of lead, or its slow introduction through unknown channels, 
hinders the conversion of uric acid into urea, and favors the deposition 
of urate of soda about the joints : hence the arthritic pains which ac- 
company the other symptoms of chronic lead-poisoning, and the intimate 
relation of the presence of lead in the organism and gouty attacks. 
The symptoms thus far sketched are chiefly those due to the influ- 
ence of the agent over the oxidation processes of the body in general. 
It is necessary now to consider the action of lead on the nervous sys- 
tem. Lead cjastralgia is an early symptom, in part due to the fact that 
the metal acts directly on the nerves of the stomach, but it is also a 
symptom of the action of the poison on the central nervous system. 
Lead arthralgia, already referred to, is frequently an affection of the 
intra-muscular nerves, and has its seat more especially in the flexor 
muscles. The swelling of the joints and the joint-pains 'are doubtless . 
due, as already explained, to the deposition of the urates in the joints 
themselves, but the term arthralgia is used to describe that form of pain 
about the joints produced by lead. Impaired sensibility to touch is also 
one of the phenomena of lead-poisoning. This lead-anaesthesia is found 
about the neck, chest, the forearms (their palmar face), hands, and 
fingers, and is symmetrically distributed* on the two sides. Ancesthesia 
of the optic (amaurosis) is also a result of the direct action of lead, but 
dimness of vision and a sluggish pupil may also be due to the albumi- 
nuria which is so frequently present. Paralysis of the common extensors 
of the fingers and of the supinators, while the power of the flexors and 
pronators is much less diminished, constitutes that very striking symp- 
tom of lead-poisoning, " the drop-wrist." When the arms are raised 
the hands drop forward and to the palmar face of the forearm, from an 
inability of the extensors to hold them up. Paralysis may invade the 
laryngeal muscles, producing aphonia. Sometimes the paralysis has the 
hemiplegic form, and, still more rarely, the paraplegic. At the begin- 
ning of the paralysis, the muscular irritability is preserved, but it soon 
lessens, and is lost finally, so that the muscles cease to respond to the 
faradic current. For some time after the induction current fails to ex- 
cite contraction, muscular movements may be obtained by a slowly- 
interrupted galvanic current. 

Death may result from the saturnine cachexia, by the gradual failure 
of nutrition, and by the extension, finally, of the muscular paralysis to 
the muscles of respiration. Death may occur much earlier, by the de- 
velopment of those symptoms to which has been applied the term lead- 
encephalopathy — a form of disease characterized by delirium and con- 
vulsions, ending in fatal coma. 



256 AGENTS INCREASING WASTE. 

Lead is very fatal to the life of the foetus, and women the subjects 
of the saturnine cachexia abort early, or produce stillborn children. 

After death, lead is found in various organs of the body, and rela- 
tively in large amount in the brain. It is also largely deposited in the 
substance of the affected muscles and nerves, and the destruction of the 
Hallerian irritability, the disappearance of the striation and the granular 
condition of the nerves, are probably due to the direct action of the metal. 
Lead, also, like the other minerals, tends to accumulate in the bver ; 
much of it is probably eliminated by the intestinal glands and skin, and 
some passes out by the kidneys. 

The treatment of lead-poisoning is prophylactic and curative. Among 
the former are, personal cleanliness, frequent bathing, the use of sul- 
phuric-acid lemonade, the habitual employment of milk in large quan- 
tity as a food, and the avoidance of all sources of contamination. Among 
the curative measures must be placed first, large doses of the iodide of 
potassium, purgative doses of Epsom salts, and sulphur-baths. The af- 
fected muscles should be early faradized to prevent atrophic changes. 
When they fail to respond to a faradic current, a slowly-interrupted 
galvanic current should be used, and after a time the faradic irritability 
may be recovered. 

Therapy. — Acetate of lead is one of the astringent remedies em- 
ployed to arrest hozmatemesis. It is more especially adapted to the 
vomiting of blood, which accompanies gastric ulcer. This salt exercises 
a favorable influence over the- course and progress of gastric ulcer ; it 
allays pain and local inflammation, and modifies the ulcerated surface. 
In chronic gastric catarrh with gastralgia and pyrosis, it has given . 
great relief. Notwithstanding the chemical incompatibility, it may be 
advautageoiisly combined with morphia in painful stomach-affections. 
The most frequent use of the acetate of lead in gastro-intestinal disor- 
ders is in the treatment of the various forms of diarrhoea. It is an ex- 
cellent remedy in the summer diarrhoea of children. T$. Plumbi ace- 
tat., grs. viij ; acid, acetic, gtts. vj ; tinct. opii deodor., gtts. iv ; aquae 
destil., fj. M. Sig. A teaspoonful every two, three, or four hours for 
a child two years of age. In choleraic diarrhoea, acetate of lead is one 
of the most useful astringents: I£. Plumbi acetat, grs. xxiv; pulv. 
opii, grs. xij ; pulv. camphorse, 3 ss ; sacch. alb. q. s. ft. pulv. no. xii. 
Sig. One powder every hour or two. It is sometimes preferable to ad- 
minister the acetate of lead in solution, when the formula above given 
for children may be used in corresponding dose for adults. Probably, 
the most generally successful remedy for the diarrhoea of p>hthisis is a 
pill containing equal parts of acetate of lead and opium. The diarrhoea 
of typhoid may also be restrained by acetate of lead and opium ; but 
generally bismuth is more suitable than acetate of lead. In acute and 
chronic dysentery lead is often a useful astringent. Enemata of lead 
and morphia (1J. Plumbi acetat., grs. iv; morphias acetat., gr. ss; aquse 



LEAD. 257 

fervid., §j) allay the tenesmus of acute dysentery. Enemata of corre- 
sponding strength to age, of the same composition, are very useful in 
the cholera infantum of children. 

Although the salts of lead undergo important chemical changes iu 
the intestinal canal, and are probably very much modified in composi- 
tion before they enter the blood, yet there is no doubt about their power 
to affect remote parts. The value of acetate of lead in various forms of 
hcemorrhuge has been attested by an immense clinical experience. 
Thus, in haemoptysis, it is a most useful haemostatic. Careful obser- 
vations on a case of severe and protracted pulmonary haemorrhage 
demonstrated that five grains of the acetate, every three hours, exercised 
a remarkable influence over the arterial tension and the action of the 
heart. Its effects are similar to those of digitalis : it slows the action 
but increases the power of the heart, while at the same time it elevates 
the tension of the arterioles. The astringent is, however, a dynamical 
and not a chemical action, doubtless. There is, therefore, a fitness in 
the prescription of Oppolzer for caseous pneumonia : I3L Inf. digitalis, 
3 iv ; plumbi acetat., 3j ; tinct. opii, 3j. M. Sig. A tablespoonful 
twice a day. A similar combination is serviceable in haemoptysis: IjL 
Plumbi acetat., 3ij; pulv. digitalis, 3j; pulv. opii, grs. x. M. ft. 
pil. no. xx. Sig. One every four hours. 

By virtue of its astringent action acetate of lead restrains secretion, 
and hence its utility in bronchorrhoza. It is also serviceable in humid 
asthma and whooping-cough. 

Formerly acetate of lead was used to quiet the action of the heart 
in hypertrophy, and to favor coagulation of the blood in the case of in- 
ternal aneurism. It might often be usefully employed in these affec- 
tions now. 

In prescribing the preparations of lead for internal use, the danger 
of producing plumb ism should not be overlooked. When it is used for 
any considerable period, the gums should be frequently inspected, and 
on the slightest appearance of a blue line, or on the occurrence of con- 
stipation and abdominal pain, the remedy should be at once discon- 
tinued. 

External Application of Lead Preparations. — The uses of lead 
preparations for external diseases are numerous and important. An 
excellent application to burns is white-lead paint — carbonate of lead 
and linseed-oil. This may be objectionable when the surface is very 
large, lest a dangerous amount of absorption take place, but for burns 
of small extent it is safe and gives great relief. The surface of the burn 
is thickly coated with the paint. Lead-lotion (liquor plumbi subace- 
tatis dilutus) is a good application to eczema when there is much weep- 
ing. The following ointment has been recommended in this affection : 
]J. Plumbi acetat., fss; camphor, pulv., grs. xv; ol. amygdal., |ij; 
cerae fiavae, fj. M. ft. cerat. An excellent formula for eczema, when 
18 



258 AGENTS INCREASING WASTE. 

there are great heat and redness, and profuse discharge, consists of liquor 
plumbi subacetatis, 3 j ; glycerinse, 3 ss ; and cherry-laurel water, § iijss. 
The following formula is recommended by Fox in eczema and lichen : 
]J. Acid, nitrici dil., 3 ss ; plumbi acetat., grs. v ; aquae, § vj. M. In 
erythema the carbonate of lead is used with advantage : ]J . Plumbi 
carb., grs. iv ; glycerinse, 3 j ; cerat. simplicis, % j. M. In impetigo 
the following: $. Plumbi acetat., grs. xv; acid, hydrccyan. dil., m. xx; 
alcoholis, § ss ; aquae, § vss. M. 

Lead-lotions are much used to cure muco-purulent and purulent 
discharges from the ear, the vagina, and the urethra. They may be 
employed at any stage, and the existence of inflammation does not con- 
traindicate their use. The following is a useful formula for gonorrhoea: 
IJ,. Liq. plumbi subacetat. dil., §"iv; zinci sulphat., grs. viij. M. Sig. 
As an injection. A chemical change, of course, takes place, but clinical 
experience is in favor of the combination. 

The ointment of the iodide of lead is often a useful application to 
enlarged lymphatic glands and to enlarged spleen. It is also employed 
with benefit in cases of chronic eczema, porrigo, and psoriasis. 

A solution of the nitrate of lead in pure glycerine (grs. x — § j) is an 
effective application to fissured nipples. It need hardly be remarked 
that the nipple should be well washed before the child is permitted to 
suck. Nitrate of lead in form of powder, dusted over the unhealthy 
granulations, gives great relief, and hastens the healing of onychia. 

Authorities referred to : 

Garrod, Dr. A. B. The Nature and Treatment of Gout, London, 1 869. 

Gussercw, Prop. Dr. Archiv fur patlwlogische Anatomie, xxi., 443. 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic, Bleisalze, p. 196, et seq. 

Hirt, Dr. Ludwig. Die Krankheiten der Arbeiter, p. 92, et seq. 

Nothnagel, Dr. Hermann. Hartdbuch der Arzjieimittellehre, Blei-Prciparafe, p. 268, 
et seq. 

Rosenstein, Prop. Dr. Archiv fur patlwlogische Anatotnie, xxxix., 1 und 174. 

Schmidt's Jahrbttcher der gesammten Medicln, vol. cxliv., p. 279. Mittheilungen 
ueber Bleivergifiung, von L. Pappenheim; E. Clapton; A. Bobiene; E. Buchner; Alois 
Gruber ; Stamm ; Bucquoy ; A. Gubler ; Nicaise ; E. Meyer ; Murchison ; Paleari ; Pan- 
thiel. 

Second Annual Report Of the State Board or Health op Massachusetts, 1871, 
p. 21. 

Tardieu, Ambroise Dictionnaire d'Hygiene publique et de Salubrite, deux. 6ditioD, 
tome troisieme, p. 334. 

Zincum. — Zinc. Zinc, Fr. ; Zink, Ger. 

Zinci Oxidum. — Oxide of zinc. " A jrellowish-wbite powder, in- 
soluble in water, but soluble in dilute sulphuric and muriatic acids with- 
out effervescence. The solutions, when neutral, yield white precipitates 
with ferrocyanide of potassium and hydrosulphate of ammonium." Dose, 
gr. ss — grs. x. 



ZINC. 259 

Zinci Carbonas JPrecipitata. — Precipitated carbonate of zinc. A 
light, white powder, resembling magnesia in appearance. 

Ceratum Zinci Carbonatis. — Cerate of carbonate of zinc. (Carbon- 
ate, 3 ij ; ointment, 3 x.) 

Zinci Sulphas. — Sulphate of zinc. " In colorless crystals, which 
effloresce on exposure to air. It is soluble in water, and the solution 
affords white precipitates with ammonia, chloride of barium, ferrocya- 
nide of potassium, and hydrosulphate of ammonium. The precipitate 
thrown down by ammonia is wholly soluble in an excess of the alkali." 
Dose, gr. \ — grs. vj. 

Zinci Acetas. — Acetate of zinc. " In micaceous crystals, which ef- 
floresce in a dry atmosphere. It is very soluble in water, and its solu- 
tion yields white precipitates with ferrocyanide of potassium and hydro- 
sulphate of ammonium. The salt is decomposed by sulphuric acid, with 
the escape of acetous vapors." Dose, gr. ss — grs. ij. 

Liquor Zinci Chloridi. — Solution of chloride of zinc. 

Zinci Chloridum. — Chloride of zinc. "A white deliquescent salt, 
wholly soluble in water, alcohol, and ether. Its aqueous solution yields 
with nitrate of silver a white precipitate, insoluble in nitric acid." 
(These preparations are for external use only.) 

Zinci Valerianas. — Valerianate of zinc. " A white anhydrous salt, 
in the form of pearly scales, having a faint odor of valerianic acid, and 
a metallic styptic taste. It dissolves in one hundred and sixty parts of 
water, and in sixty of alcohol of the specific gravity of 0.833." 

Unguentum Zinci Oxidi. — Ointment of oxide of zinc. (Oxide of 
zinc, 80 grains; ointment of benzoin, 400 grains.) 

Antagonists and Incompatibles. — Lime-water, the alkalies and 
their carbonates, nitrate of silver, and the vegetable astringents, are 
incompatible with zinc-salts. The acetate of lead is also incompatible, 
but a solution containing sulphate of zinc and acetate of lead, notwith- 
standing the double decomposition which ensues, is an effective injec- 
tion in gonorrhoea. With valerianate of zinc, acids, many of the metal- 
lic salts, soluble carbonates, and vegetable astringents, are incompatible. 
The antagonists to be used in cases of poisoning by the zinc-salts are 
lime-water, mucilaginous drinks, milk, tannic acid, the carbonated alka- 
lies, common soap, etc. 

Synergists. — The mercurial, silver, antimonial, and copper prepara- 
tions, favor the action of the zinc-salts. 

Physiological Actions. — The preparations of zinc are active in 
proportion to their solubility and power of diffusion. The chloride, the 
sulphate, and the acetate, are the most active, and in the order in which 
they are placed ; the carbonate and the oxide being insoluble, have very 
feeble diffusive power, and possess consequently very slight activity. 
The chloride is a very active escharotic. Applied to the denuded integu- 
ment it sets up decided inflammation, and produces an intense burning 



260 AGENTS INCREASING WASTE. 

pain, followed by sloughing. Owing to its great affinity for water and 
power of combination with albumen, it penetrates deeply and widely, 
and the eschar which it produces is thick, hard, and white. The dried 
sulphate of zinc (deprived of its water of crystallization by heat) is also 
feebly escharotic when applied to an open wound. Solutions of the 
sulphate and acetate act locally as astringents by combining with albu- 
men. 

The soluble salts of zinc have a styptic metallic taste, which is very 
disagreeable. The sulphate of zinc is a very prompt and efficient emetic, 
acting without much ■ preliminary nausea, and without much constitu- 
tional depression. It is a specific emetic; it acts to produce emesis 
when injected into the veins. Long-continued use of the sulphate, even 
in small medicinal doses, may excite ulceration of the mucous membrane. 
The oxide and carbonate, although insoluble and inactive, slowly pro- 
duce systemic effects. The chloride is a powerful irritant poison, caus- 
ing heat and a sense of constrictiou of the throat, a strong metallic 
taste, burning at the stomach, nausea, vomiting, great depression of the 
pulse, coldness of the surface, cold-sweat, cramps of the legs, etc. The 
mind is unaffected. In a few instances nervous symptoms have fol- 
lowed, besides the cramps, and in one notable case there was loss of the 
senses of taste and smell. 

All of the salts of zinc, when long continued, may produce a train 
of symptoms not unlike those caused b) T lead, viz., emaciation, pallor, 
loss of strength, constipation and colic, muscular weakness and trem- 
bling, paralysis, etc. The oxide in large doses, and used for a long peri- 
od, has produced wasting, a fetid breath, gastro-intestinal catarrh, weak- 
ness, and feeble mind. 

The zinc-salts most probably exist in the blood in the form of albu- 
minate, and in close relation to the red blood-globides. They manifest 
much less tendency to accumulate, and are excreted much more rapidly 
than mercury, lead, and copper. They diffuse out of the blood chiefly 
by the liver and intestinal glandular apparatus, and are found in great 
quantity in the fasces. To a slight extent they are also excreted by the 
kidneys. 

Therapy. — The sulphate of zinc is much employed as an emetic in 
cases such as narcotic poisoning, where prompt and efficient action is 
necessary. Six grains will generalhv prove sufficient. It may be re- 
peated every fifteen minutes, well diluted with water, until emesis oc- 
curs. It was formerly much employed as an emetic in croup, but now 
tartar-emetic, but especially the subsulphate of mercury, is preferred. 

The oxide of zinc is an excellent remedy for gastralgia. It is indi- 
cated also in the following state of things: pain after taking food, nau- 
sea, intestinal pain, succeeded by prompt alvine discharges, the faeces 
being made up largely of undigested food. From five to ten grains 
mixed with aromatic powder and combined with morphia, if need be. 



ZINC. 261 

may be given before each meal. In the summer diarrhoea of children, 
it is a very efficient remedy. It may be administered with bismuth and 
pepsin, fy. Bismuthi subnitrat., 3j — 3 ij ; pepsina) sacoh. (Sheffer's), 
3ss; zinci oxidi, grs. vj — grs. xij. M. ft. pulv. no. xii. Sig. One pow- 
der every four to six hours. In the chronic diarrhoea both of children 
and adults the oxide of zinc (from two to ten grains) is serviceable un- 
der the same circumstances in which bismuth is presumed to be indi- 
cated, but it is a less pleasant remedy in action than the latter. The 
sulphate (gr. ss — grs. ij) often gives great relief in that form of dys- 
pepsia which is the cause of oxaluria. In small doses, the sulphate, 
like most of the mineral remedies of this group, increases for a time the 
appetite and digestive capacity, but this effect is soon succeeded by gas- 
tro-iutestinal catarrh, nausea, and loss of appetite. The sulphate as 
well as the oxide, is an astringent ; it arrests the peristaltic movements 
and causes constipation, and is therefore an appropriate remedy in 
chronic diarrhoea and chronic dysentery. In its action and results it 
is similar to but less efficient than sulphate of copper. It may be com- 
bined with opium and ipecacuanha: I£. Zinci sulphat., pulv. opii, pulv. 
ipecac, aa grs. xij. M. ft. pil. no. xij. Sig. One pill three or four 
times a day. 

The zinc preparations possess undoubted efficacy in certain disorders 
of the thoracic organs. The night-sweats of phthisis are often prevent- 
ed by a pill of oxide of zinc and extract of belladonna (three grains of 
the former and half a grain of the latter) given at bedtime. The zinc 
is serviceable without the belladonna, but the combined action is more 
efficient. The sulphate of zinc, by virtue of its astringency, has been 
prescribed in bronchorrhoea, but other agents are now preferred. The 
oxide of zinc is a serviceable prophylactic against the recurrence of the 
attacks of spasmodic asthma. It is also one of the numerous remedies 
which has been used with a varying degree of success in whooping- 
cough: 5. Zinci oxidi, 3j; ext. belladonnse, grs. v. M. ft. pil. no. xx. 
Sig. One pill three times a day. A prophylactic for asthma, and as a 
remedy for whooping-cough. The sulphate of zinc (gr £ — gr. j) and ex- 
tract of belladonna (gr. -J — gr. ss) may be used in combination for the 
relief of the same cases. It is highly probable that the sulphate of zinc, 
being more soluble, is much more efficient in the treatment of these 
neuroses of the digestive organs than the oxide. 

The preparations of zinc exert an influence upon the nervous system 
which has been and is called antispasmodic. In certain disorders of the 
nervous system, of which the chief manifestations are spasm and con' 
vulsion (clonic), they are sometimes very serviceable. Much has been 
said for and against the oxide of zinc as a remedy for epilepsy. A few 
cases are improved by it ; in the great majority it fails utterly. The 
author expresses with diffidence his conviction that this remedy is most 
useful in those cases in which the peripheric irritation has its origin in 



262 AGENTS INCREASING WASTE. 

the stomacli ; it acts by allaying irritability of the terminal filaments of 
the pneumogastric, and probably also by removing a diseased state of 
the gastric mucous membrane. Epileptiform vertigo and epileptiform 
angina pectoris, when they arise (as they not unfrequently do) from 
gastric disorder of some kind, are sometimes cured by the oxide of zinc. 
Tiie so-called nervous headache of hysterical women, nervous cough, 
and aphonia, due to uterine and ovarian irritation, are often relieved 
by the valerianate of zinc. Sulphate of zinc is one of the numerous 
remedies for chorea, acting in a manner similar to arsenic, but inferior 
to this agent in curative power. In neuralgia due to reflex irritation 
from the female pelvic organs, the preparations of zinc, notably the va- 
lerianate, are often extremely beneficial. ]J. Zinci Valeriana!, 3j; 
ext. gentians, 3 j ; ext. nucis vom., grs. v. M. ft. pil. no. xx. Sig. 
One pill three or four times a day. In chronic alcoholismus, to relieve 
the trembling, to diminish the appetite for strong drink, and to relieve 
the gastric catarrh, the oxide of zinc is very useful : $. Zinci oxidi, 
3j; piperin., 3j. M. ft. pil. no. xx. Sig. One pill three or four times 
a day. 

Externa! Uses. — The author has personal knowledge of several 
cases of caries cured by the injection of Villate's solution. The follow- 
ing is the composition of this fluid : Sulphate of copper, sulphate of 
zinc, of each 15 parts ; solution of subacetate of lead, 30 parts ; vinegar, 
200 parts. The sinus or sinuses leading to the carious bone should be 
thoroughly injected with the solution. It need hardly be remarked that 
this treatment would not remove a sequestrum. 

An excellent caustic for the destruction of lupus, epithelioma, and 
unhealthy ulcers, is the dried sulphate of zinc, which m&y be freely 
dusted over the affected surface. A superficial slough forms, the sepa- 
ration of which may be aided by a poultice. The most efficient escha- 
rotic consistent with safety is the chloride. No danger is to be appre- 
hended from its absorption, and the strength of the application may be 
easily regulated. For the destruction of malignant growths, chloride of 
zinc is applied of varying strength, by the admixture of different propor- 
tions of flour, or better, of powdered althea-root, so as to form a paste, 
sufficient water being added. One part of the chloride to two, three, 
four, or five parts of flour are the proportions advised by Dr. Canquoin. 
Instead of flour, the chloride may be mixed with anhydrous sulphate of 
lime. A very convenient and useful mode of applying chloride of zinc 
is, to mix it, while in a finely-powdered state, with its weight of gutta 
percha melted with as little heat as possible. The mixture may be 
moulded into any desired shape. The so-called " caustic arrows " are 
nothing more than chloride-of-zinc paste, dried and cut into arrow-like 
slips. These are inserted into the malignant growth, usually at its base, 
in order to separate it from the healthy tissues. 

The salts of zinc are useful applications to certain forms and stages 



ANTIMONY. 203 

of skin-diseases. In eczema, during the secretory stage, the following 
may be used: I£. Zinci oxidi, 3 ij ; glycerinae, § ij ; liq. plumbi sub- 
aeetat., 3jss; aquae calcis ad 3 vj. M. Sig. Lotion (Fox). This 
formula is serviceable also in impetigo and herpes. An excellent ab- 
sorbent powder for excoriated surfaces is the following : I£ . Corn- 
meal, finely sifted, l'iv; oxide of zinc, 3J; iris powder, 3SS; oil of 
almonds, gtts. x. M. The following is recommended by Neumann in 
seborrhcea, when there is inflammation: 1£. Zinci oxidi, 3j; plumbi 
carbonat., 3 j ; cetacei, 3 j ; ol. olivae q. s. ft. ung. Sig. Ointment. In 
erythema, intertrigo, and eczema, the following lotion is useful : IJ. 
Aluminis, 3j; zinci sulph., grs. x; glycerina?, 3 j ; aquae rosae, |iv. M. 
Sig. Lotion. For erythema and herpes, the following may also be used: 
IJ. Zinci acetat., grs. ij ; aquae rosse, 3j; ung. aquae rosae, 3 j. M. 
Siir. Ointment. The ointments of the oxide of zinc and the cerate of 
the carbonate are excellent applications in many of the cutaneous affec- 
tions above named. 

Probably the most efficient means for treating gonorrhoea consists 
in the use of a weak zinc-injection frequently repeated. IJ. Zinci 
chloridi, gr. j ; aquae rosae, 3 iv — 3 viij. M. Sig. As an injection. 
IJ. Zinci sulph., grs. viij ; aquae rosae, 3 viij. M. Sig. As an injection. 
After the acute symptoms have subsided, the following injection is very 
effective : IJ. Zinci sulphat., plumbi acetat., aa grs. viij ; ammoniae mu- 
riat., aluminis, aa, grs. iv; aquae rosa?, 3 j. M. Sig. As an injection. 

The sulphate of zinc is very much prescribed by the ophthalmologists 
in conjunctivitis, otorrhoza, etc. It is usually associated with morphia 
and atropia. IJ. Zinci sulphat., grs. ij — grs. viij; morphiae sulph., grs. 
ij — grs. iv ; atropiae sulph., gr. ss — gr. j ; aquae rosae, f j. M. Sig. 
For the eye. 

Authorities referred to : 

Fox, Dr. Tilbcry. On Diseases of the Skin, second American edition. 

Gcbler, Dr. Adolphe. Commentaires TAerapeutiqucs du Codex Medicamentarius. 

Hirt, Dr. Ludwig. Die Krankheiten der Arbeiier, erster Theil, Breslau, 1871, p. 97, 
et seq. 

Nothnagel, Dr. Hermann*. Handbuch der Arzneimillellehre, p. 281, et seq., Zink- 
Praparate. 

Simpson, Sir James Y. Clinical Lectures on Diseases of Women, American edition, 
1872, p. 195. 

Trousseau et Pidoux. Traite de Therapeutique et de Matiire Medicate, eighth edi- 
tion by Paul. 

United States Dispensatory, thirteenth edition. 

Waldenburg und Simon. Handbuch der aUgemeinen vnd speeiellen Arzneiverordnv.ngs- 
fehre, Berlin, 1873. 

Antimoilium. — Antimony. Antimoine, Fr. ; Antimon, Ger. 
Antimonii et Potassii Tartras. — Tartrate of antimony and potassi- 
um. Tartar-emetic. " In transparent crystals, which become white and 



264 AGENTS INCREASING WASTE. 

opaque on exposure to the air. It is wholly soluble in twenty parts of 
water. The solution yields no precipitate with chloride of barium, or, 
if very dilute, with nitrate of silver. Hydrosulphuric acid causes an 
orange-red precipitate. A solution containing one part in forty of water 
is not disturbed by an equal volume of a solution of eight parts of ace- 
tate of lead in thirty-two of water and fifteen of acetic acid." Dose, 

g r - tV-grs- ij- 

Emplastrum Antimonii. — Antimonial plaster. (Tartrate of anti- 
mony and potassium, |j; Burgundy pitch, §iv.) 

Unguentum Antimonii. — Antimonial ointment. (Tartrate of anti- 
mony and potassium, 100 grains ; lard, 400 grains.) 

Vinum Antimo nii.-^ Antimonial wine. (Solution of tartar-emetic 
in sherry wine, 32 grains to the pint ; two grains to the ounce.) Dose, 
m. v— 3 ij. 

Syrupus Scillce Compositus. — Compound sirup of squill. Hive- 
sirup. (Squill, seneka, tartar-emetic. Contains one grain of tartar- 
emetic to the ounce.) Dose, m. v— 3j. 

Antimonii Oxidum. — Oxide of antimony. " A grayish-white pow- 
der, insoluble in water, but readily and wholly soluble in muriatic or 
tartaric acid." Dose, gr. j — grs. iij. 

Antimonii Oxysulphuretum. — Oxysulphuret of antimony. "Is a 
purplish-brown, tasteless powder, soft and velvety to the touch, wholly 
and readily soluble in muriatic acid with evolution of hydrosulphuric- 
acid gas." Dose, gr. j — grs. iij. 

Antimonii Sulphuratum. — Sulphurated antimony. " Is a reddish- 
brown powder, insoluble in water." Dose, gr. j — grs. v. 

In the remarks which follow, tartar-emetic is the only antimonial 
preparation referred to, unless otherwise stated. None of the other 
preparations are employed by modern physicians. 

Antagootsts and Lstcompatibles. — Tannic and gallic acids, and 
vegetable infusions containing them, form an insoluble tannate, and are 
therefore incompatible. Alkalies and the salts of lead decompose tar- 
tar-emetic. It follows that the proper antidotes to poisoning by tartar- 
emetic are tannic acid (green tea, catechu, rhatany, rhubarb, etc.). Opi- 
um, alcohol, ether, etc., and the antispasmodics generally, are physio- 
logically antagonistic. 

Synergists. — The mineral substances of this group promote the ac- 
tion of the antimonials ; also the emetics and cathartics, and depressing 
remedies generally, as veratrum viride, etc. 

Physiological Action's. — Tartar-emetic has a sweetish, styptic, and 
metallic taste. In small medicinal doses, it excites a sensation of warmth 
in the stomach, followed by nausea, increased flow of saliva and buccal 
mucus, an abundant secretion of the gastric and intestinal glandular ap- 
paratus, and also of the liver and pancreas. In somewhat larger doses — 
a half-grain to one or two grains — it excites vomiting, first of the con- 



ANTIMONY. 265 

tents of the stomach, then of gastric mucus, and afterward of mucus 
and biliary matters. The alvine dejections are more fluid and increased 
in number, and consist at first of fluidified faeces ; afterward they are 
made up of a colored liquid, in which there are present biliary matters 
and some faeces ; and, finally, there appears only a colorless or whitish 
liquid, having flocculi of epithelium floating in it, and bearing a strik- 
ing resemblance to the " rice-water discharges " of cholera. 

The ga&tro-intestinal symptoms are accompanied by systemic dis- 
turbance — paleness of the face, coldness of the surface (sometimes pre- 
ceded by a very temporary rise of temperature), irregularity and feeble- 
ness of the pulse, and great nervous and muscular prostration. When 
the quantity is sufficient to cause lethal symptoms, they are as follows : 
epigastric pain, vomiting and purging, shrunken features, cold breath, 
cyanosis, arrest of the urinary secretion, aphonia, cramps — the assem- 
blage of symptoms belonging to the collapse of cholera. 

Tartar-emetic, when used in considerable medicinal doses, sets up an 
irritation of the fauces followed by aphthous ulcerations, which continue 
along the oesophagus to the stomach, and are accompanied by saliva- 
tion and painful deglutition. 

Applied to the skin by friction, tartar-emetic excites a follicular in- 
flammation, succeeded by a papule, a vesico-pustule, a surrounding in- 
flammation with indurated base, a central umbilication, and finally des- 
iccation, terminating in a brownish scab. These antimony-pustules are 
very similar to those of vaccine or variola. 

When applied to the skin or injected into the veins, tartar-emetic is 
absorbed, and manifests a selective action on the gastro-intestinal mu- 
cous membrane, causing the same irritant effects as are produced by its 
stomach administration. It is, therefore, a specific, and not a merely 
irritant emetic. 

Tartar-emetic readily diffuses into the blood. In what form, unless 
as an albuminate, it exists in the blood, is not understood. It dimin- 
ishes the number and force of the arterial pulsations, and rapidly lowers 
the blood-pressure. The pulse may fall from 72 to 40, but, according to 
Hirtz, rarely is the number reduced more than 6 to 10 per minute. In 
the healthy subject, the normal temperature, even when a full medici- 
nal dose has been administered, remains unaffected as to the trunk, 
but it may be reduced in the extremities. In fevers and inflamma- 
tions, a considerable reduction of temperature may take place, and 
the same result has been noted in the physiological state when the 
quantity of tartar-emetic has been sufficient to produce choleriform 
symptoms. 

In man delirium, and in animals paralysis, motor and sensory, but 
without impairment of muscular contractility, have been observed from 
lethal doses of tartar-emetic. 

Tartar-emetic promotes waste and hastens the elimination of the 



266 AGENTS INCREASING WASTE. 

products of waste — the excretion both of carbonic acid and of urea 
being greatly increased by it. 

The antimonial salts are found in the blood, in the liver, and other 
viscera, and are excreted by the bile, the milk, the perspiration, and the 
urine. It is, doubtless, also largely excreted by the intestinal glandu- 
lar apparatus, as is the case with the metals generally. 

If tartar-emetic is administered in small doses, and the quantity 
be gradually increased, the nauseating effects of the drug may be 
entirely prevented. When emetic doses even are continued in some 
subjects, this effect finally ceases, and the drug is borne without pro- 
ducing any gastric symptoms. To this state has been applied the 
term tolerance, by the contra-stimulant school of practitioners. It 
must not be lost sight of, that this tolerance, on the part of the stom- 
ach, of large doses does not mean an indifference to the action of 
the remedy, but very serious and profound anatomical alterations may 
result. 

Therapy. — Tartar-emetic was, formerly, much more frequently pre- 
scribed than at present as an emetic in cases of indigestion, character- 
ized by a coated tongue, loaded stomach, and anorexia (Pembaiyas gas- 
trique). It is sometimes used as an emetic in cases of narcotic poison- 
ing, but sulphate of zinc is preferable. It was formerly used as an 
emetic in the first stage of typhoid and other fevers, but, notwithstand- 
ing this practice is frequently followed by good results, it is now rarely 
pursued. If emesis is desirable in these cases, a less irritating and de- 
pressing emetic should be used. 

In croup tartar-emetic is an efficient emetic, but it must be used 
with caution, owing to the great depression which it produces, and the 
fatal result which has occurred in many instances. It is not a suitable 
remedy for infants and very young children. The compound sirup of 
squills is a domestic remedy for croup, but the incautious use of this 
has proved fatal. Tartar-emetic is used in laryngismus stridulus to 
produce emesis and consequent relaxation of the muscles of the larynx, 
and in true croup to cause the expulsion of the false membrane. The 
yellow subsulphate of mercury is safer and quite as effective. 

Tartar-emetic is an excellent remedy in the first stage of acute ca- 
tarrh, nasal, pharyngeal, and bronchial. It is most efficient in the first 
stage, when the mucous membrane is dry and swollen. It promotes 
secretion, diminishes fever, induces diaphoresis, and hastens the elimi- 
nation of inflammatory products. In these cases, from one-twentieth 
to one-twelfth of a grain is usually a sufficient quantity, for it is not 
necessary that nausea be excited. When cough is violent, a little opium 
may be added to the prescription. Ifr. Antimonii et potassii tart., gr. ss ; 
morphias acetat., gr. ss; aquae, § ij. M. Sig. A teaspoonful every 
hour or two. In acute bronchitis, when the cough is dry and hoarse, 
this agent is useful, and small doses (one-sixteenth of a grain), fre- 



ANTIMONY. 267 

quently repeated, are more serviceable than large doses at longer in- 
tervals. 

Formerly, under the influence of the contra-stimulant school, tartar- 
emetic was given in large doses in pneumonia. It was sought to es- 
tablish tolerance at an early period, and to administer the largest doses 
which could be borne. The comparative results of this method of 
treatment and of the expectant and restorative plans demonstrate the 
impropriety of the tartar-emetic treatment, and it is now abandoned. 
It is true that small doses of tartar-emetic, by increasing the action of 
the skin, kidneys, and intestinal canal, may exert a favorable influence 
over the temperature and diminish the plasticity of the exudation ; but 
even small doses must be employed with care, lest a depression should be 
induced which may interfere seriously in the natural course of a disease 
which is self-limited and has its period of crisis. 

Tartar-emetic gives great relief in spasmodic asthma when the bron- 
chial secretion is deficient, and in those cases brought on by an over- 
loaded stomach. In the former case small doses frequently repeated 
until very slight nausea is produced, and in the latter emetic doses, are 
necessary. The following is a useful form of expectorant in the acute 
inflammatory affections of the air-passages: 5. Antimonii et potassii 
tart., gr. j; ammonii muriat., 3iv; ext. glycyrrhizae, 3j; morphiae 
muriat., gr. j ; syrup, tolutan., aquae lauro-cerasi, aa § j. M. Sig. A 
teaspoonful every two, three, or four hours. 

The ointment of tartar-emetic was formerly much employed to pro- 
duce pustulation of the chest in the more chronic pulmonary diseases. 
This painful and disfiguring form of counter-irritation has passed out of 
use. To produce a crop of variolus-like pustules on the skin does not 
cause a morbid process like caseous pneumonia or tuberculosis to cease 
its ravages ; on the contrary, such extensive suppuration in the skin 
rather favors the development of these diseases. 

A combination of tartar-emetic and opium is a serviceable hypnotic 
in some cerebral disorders. These remedies appear to be most useful 
when wakefulness and delirium are due to cerebral congestion, and 
in those subjects who become excited and wakeful from the use of opium 
alone. In the active delirium and wakefulness of typhoid fever, tar- 
tar-emetic and opium are prescribed: $. Antimonii et potassii tart., gr. 
j — grs. ij ; morphiae sulph., gr. jss ; aquae lauro-cerasi, % j. M. Sig. A 
teaspoonful every two, three, or four hours. In delirium tremens, when 
the same conditions exist, the same combination may be prescribed. 
Since the introduction of chloral and bromide of potassium, however, 
the use of these drugs for the purposes just indicated has been much 
restricted. 

In acute inflammatory and febrile diseases, minute doses of tar- 
tar-emetic (gr. -jig-), frequent!}'- repeated, render an incontestable ser- 
vice. Typhoid, typo-malarial, and remittent fevers, acute rheuma- 



268 AGENTS INCREASING WASTE. 

tism, erysipelas, etc., are maladies thus benefited. This remedy is, of 
course, contraindicated when there is much irritability of the stomach 
and intestinal canal. At the outset of fevers it was formerly the cus- 
tom to prescribe an active emetic, and good results certainly followed 
this practice. The author believes that he has frequently seen impend- 
ing- attacks of malarial fever aborted by emetic doses of antimony and 
ipecac. Free emeto-catharsis moderates the severity of remittent fever 
in robust subjects when produced in the incipiency of this disease, and 
also puts the mucous membrane in a better state for the disposition of 
medicines and food. 

Before the days of anaesthesia tartar-emetic was much used to relax 
the muscular system for the reduction of dislocations, to facilitate the 
taxis in strangulated hernia, to relieve rigid os and perinceum in labor, 
etc., but it is now no longer employed for these purposes. 

Authorities referred to : 

Gubler, Dr. A. Commentaires TMrapeutiques du Codex Medicamentarius, p. 624, et seq. 

Hermann, Dr. L. Lehrbuch der experimentcllen Toxicologic, p. 218, Anlimonsalze. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellchre, p. 218, ct seq., Anlimon- 
Prdparate. 

Radziejewsky, Dr. S. Schmidts Jahrbucher der gesammten Medicin, vol. cliii., p. 10, 
Zur Wirkung des Antimon. 

Taylor, Dr. A. S. On Poisons, American edition, p. 476. 

Trousseau et Pidoux. Traite de Therapeutique et de Mature Medicale, edition by 
Paul, huitieme edition, vol. ii., p. 951. 

Cadmium. — Cadmium. Cadmium, Fr. ; Kadmium, Ger. ; Cadmii 
Sidphas, Sulphate of Cadmium. 

x\ctions and Uses. — There is a strong resemblance — an identity 
of action, indeed — between zinc and cadmium, except that the latter is 
the stronger. Cadmium has a decidedly caustic and astringent taste; it 
is powerfully nauseant and emetic, producing great depression of the 
powers of life. Locally the effects are those of an irritant poison, and 
the systemic effects correspond ; although there are produced such 
cerebro-spinal symptoms as coma and convulsions. This agent is not 
administered internally, the preparations of zinc being preferred for all 
purposes to which cadmium might be applied as a remedy. 

In ophthalmic practice, cadmium seems to be much esteemed as a 
collyrium. It is held to possess special powers in causing absorption 
of opacities of the cornea: rj. Cadmii sulph., grs. ij ; aquae rosse, 3 j. 
M. Sig. Collyrium. A solution of the same strength is said to be an 
excellent local application in otorrhoea. There is no doubt that cad- 
mium is an efficient injection in gonorrhoea y but it is important in the 
application of this, as of so many other astringent remedies, that it be 
not too strong — one grain of cadmium sulphate to four ounces of water 
being sufficient in most cases. 

An ointment of cadmium is used somewhat by French physicians, 



CERIUM. 2G9 

in the treatment of external affections. For this purpose we may direct 
ten grains of the sulphate to be intimately incorporated with an ounce 
of simple ointment. 

Cerium. — Cerii Oxalas, Oxalate of Cerium. A white powder, in- 
soluble in water, alcohol, and ether. Dose, two to five grains in pill- 
form, as it is insoluble in the ordinary menstrua. It may be suspended 
in mucilage. 

Sir James Simpson was the first to propose the use of oxalate of 
cerium to restrain vomiting arising from various causes, especially from 
pregnancy ; and he brought forward many cases illustrative of its 
value. As he pointed out, it sometimes succeeds immediately, but 
usually the best effects are experienced after several days' use. The 
oxalate of cerium sometimes succeeds remarkably in vomiting due to 
serious organic lesions, as in cancer (Peters). It has been narrated in 
one case, that four grains were administered every two hours until about 
COO grains were taken. The good result which followed this large ad- 
ministration of the drug indicates that, in vomiting from similar causes, 
larger doses may be sometimes necessary to secure the best curative 
effects. In chronic diarrhoea, cerium may take the place of bismuth. 

In cases of cough associated with vomiting, excellent results have 
been obtained from the oxalate of cerium. It is probable that the cough 
is reflex in origin, the point of irritation existing in the terminal fila- 
ments of the pneumogastric in the gastric mucous membrane. 

Alumen. — Alum. Alun, Fr. ; Alaun, Ger. 

Alummis et Potassii Sulphas. — Potassa alum. "A white, slightly- 
efflorescent salt, crystallizing in regular octahedrons, and possessing an 
acid, sweetish, astringent taste. It dissolves in from fourteen to fifteen 
times its weight of cold, and three-fourths of its weight of boiling water, 
but is insoluble in alcohol." 

Alumen Exsiccaturn. — Dried alum. Alum deprived of its water of 
crystallization by heat. 

Alumlnis Sulphas. — Sulphate of aluminum. " Has a sour, some- 
what sweetish, and astringent taste, and an acid reaction. It is soluble 
in twice its weight of water." 

Antagonists and Incompatibles. — Alkalies and their carbonates 
and acetate of lead are chemically incompatible; 

Synergists. — The mineral and vegetable astringents promote its 
therapeutical activity. 

Physiological Actions. — The sweetish taste of alum first experi- 
enced is quickly followed by a decided astringency. It provokes an 
abundant flow of saliva, and the albumen of the saliva and buccal mucus 
is coagulated in whitish, membrane-like flakes. Contraction of the 
capillaries, blanching of the mucous membrane, and subsequent dimi- 



270 AGENTS INCREASING WASTE. 

nution of secretion, take place ; hence the dryness of the throat, thirst, 
and constipation, which result from its use. In doses of a teaspoonful, 
or more, alum is an efficient emetic. Under certain morbid states it 
also proves laxative. Notwithstanding its power to coagulate albumen, 
it is absorbed into the blood, as was shown by Orfila, and may be found 
in the liver and in the urine. Circulating in the blood, alum affects the 
capillaries, diminishing their calibre, lessens secretion, especially of the 
mucous membranes, and arrests haemorrhage. In very large doses alum 
produces decided irritant effects — nausea, vomiting, abdominal pain, 
diarrhoea, etc. 

Dried alum, in consequence of its strong affinity for water, and its 
power to coagulate albumen, is a mild escharotic. 

Therapy. — Alum is one of the remedies which may be used in 
gastric catarrh. It is said to be most effective when there is vomiting 
of glairy mucus. I£. Aluminis, 3 ij ; extract, gentian., 3 ss. M. ft. 
pil. no. xxx. Sig. Two pills three times a clay. Alum is a serviceable 
haemostatic in hmmatemesis. It is, of course, adapted only to cases of 
passive haemorrhage, when there is a relaxed condition of the mucous 
membrane. Other astringents — as, for example, Monsel's salt — are 
more effective. "When intestinal hemorrhage is dependent on mechani- 
cal causes (cirrhosis, for example), and the mucous membrane is free 
from acute inflammation, alum is a serviceable astringent. It was for- 
merly much used in chronic diarrhoea and chronic dysentery, but more 
effective agents are now employed in these diseases. The following 
formulae are applicable to the above-mentioned diseases, in the absence 
of more suitable agents: IJ. Aluminis, 3 ij ; pulv. aromat., 3j; pulv. 
opii, grs. vj — grs. xij. M. ft. pulv. no. vj. Sig. One powder, in honey 
or sirup, three times a day or oftener. J>. Aluminis, 3j; extract, 
opii, grs. x ; catechu, 3 j. M. ft. pil. no. xx. Sig. Two pills every two, 
three, or four hours. $ . Aluminis, 3 ij ; pulv. opii, grs. iij — grs. vj ; 
pulv. kino, 3j; sacch. lactis, 3 j. M. ft. pulv. no. vj. Sig. One poio- 
der every three hours. 

It is a singular fact that the most effective agent for the cure of 
colica pictonum is alum. It relieves the pain and nausea, and over- 
comes the constipation, more certainly than any other agent. The 
chemical theory of its action is entirely unequal to the explanation of 
its remarkable effects ; the conversion of any portion of the lead pres- 
ent in the intestinal canal into the insoluble sulphate would not suf- 
fice to quiet pain, relieve flatulence, and relax the obstinately-con- 
stipated bowels. Its action is doubtless dynamical ; it overcomes the 
relaxation and paresis of the muscular layer, on which the phenomena 
of lead-colic depend. The following are convenient formulas for the 
administration of alum in this disease: IJ. Aluminis, 3 ij ; acid, sul- 
phuric, dil., 3 j ; syrp. limonis, § j ; aquae, § iij.- M. Sig. A table- 
spoonful every hour or two. 5 . Aluminis, 3 ij ; vini, 3 iv ; catechu, 



ALUM. 271 

3 j ; tragacanthae, 3 j ; aquae, 3 viij. M. Sig. A tablespoon ful every 
hour. Alum-whey, prepared as follows, may be used in lead-colic : To 
a pint of boiling milk, add ninety grains of alum-powder ; separate the 
curd, and sweeten the whey if desired with an ounce of white sugar. A 
wineglassful may be taken every hour or two. 

Alum not unfrequently affords relief in gastralgia, enteralgia, and 
catarrh of the intestines. It is a serviceable laxative in females of lax 
fibre, in whom constipation depends upon a paretic state of the muscu- 
lar layer of the bowel. .It is true that we possess many other agents 
more agreeable for administration, and also more effective ; but alum is 
cheap, and always to be obtained. 

Alum, dissolved in infusion or solution of the extract of logwood, is 
a useful injection in hemorrhage from the rectum, or as an application 
to bleeding piles, or as an astringent wash in prolapsus of the rectum in 
children, A crystal of alum, cut into a globular shape, may be passed 
into the rectum in such cases. The following ointment may be ap- 
plied to hemorrhoids when they protrude, bleed, and are painful: ]J. 
Pulv. aluminis, 3 ij 5 pulv. camphora?, pulv. opii, aa 3 j ; unguent., § j. 
M. Sig. Ointment. 

Notwithstanding the theoretical objections which have been made 
as to its utility, the use of alum is sanctioned by high authority in 
haemorrhages from distant organs of the body. Oppolzer recommends 
the following formula: IJ. Aluminis, amy li, aa 3j; sacchari, 3 ij. M. 
ft. pulv. no. vj. Sig. One powder every two hoicrs. Skoda advises the 
following formula in haemoptysis : IJ. Aluminis, 3j; sacch. alb., 3 ss ; 
pulv. ipecac, comp., 3j. M. ft. pulv. no. vj. Sig. One powder every 
two hours. 

Alum was formerly used in diabetes mellitus, but more effective 
methods of treatment have taken its place. Good results have cer- 
tainly been produced by the use of alum in diabetes insipidus. Colli- 
quative sieeats are moderated by the internal use of alum, and by spong- 
ing the surface with a solution. 

Alum has been used with a certain measure of success in whooping- 
cough, during the spasmodic stage, but the more certain and palatable 
remedies now in our possession have quite displaced it. As an emetic 
in croup, there is no doubt of the utility of alum. It is used to cause 
the dislodgement of the false membrane, and to prevent its reformation. 
It acts without depressing the bodily functions, is prompt, and thor- 
ough. A teaspoonful of the powder, mixed with honey or sirup, may 
be given, and repeated every half-hour until free emesis occurs. 

External Uses of Alum. — A solution of alum, in nitric ether, is 
said to be an effective application in toothache ( 3 i j — 3vij). When 
the gums are spongy and ill-conditioned, and manifest a tendency to 
recede from the teeth, the following local application is very service- 
able: IJ. Aluminis, 3 j; vini, Oj ; tinct. cinchonse, 3 ss; tinct. myrrhae. 



272 AGENTS INCREASING WASTE. 

3 ij ; mel. rosas, 3 ij. M. Sig. As a mouth-wash. When there is much 
relaxation of the faucial mucous membi-ane, alum and sugar, in equal 
proportions, may be applied by an insufflation- tube. Powdered alum, 
dusted over the affected surface, is a useful application in chronic 
pharyngitis, chronic tonsillitis, chronic nasal catarrh. Ulcers of the 
mouth, whether syphilitic, or due to nursing, or arising from gastric 
disorder, are improved in character by application of a crystal of alum. 
A useful gargle in various affections of the mouth and throat is the fol- 
lowing : Ij!, . Infus. lini, § xv ; tinct. kino, § j ; aluminis, 3 ij. M. Sig. 
As a gargle. 

In catarrhal ophthalmia, after the acute symptoms have subsided, 
an alum-lotion is useful, r^. Aluminis, 3j; aquas rosa?, liv. M. Sig. 
Lotion. Alum-curd is a domestic application which is often service- 
able : 3 ss of alum to the white of an egg. 

The following is a useful injection in chronic gonorrhoea: r>. Alu- 
minis, 3 j ; zinci sulphatis, 3 ss ; sodii biborat., grs. iv ; aquas rosse, 1 viij. 
M. Sig. An injection. This prescription is equally applicable to 
leucorrhoza. 

Alum is a useful haemostatic, but there are others more powerful. 
Alum is a constituent of the once famous Pagliari's mixture (Mentel's). 
IJ. Benzoini, gr. c; alcohol, fort., 3 ss. Dissolve and add water, fx; 
alum, 3" j. The mixture is to be boiled until clear, and, when cool, fil- 
tered. This is also a good preservative solution for anatomical prepa- 
rations, and is an effective application in leucorrhoea, pruritus of the 
vulva, etc. 

Alum § ss, the whites of four eggs, and tincture of camphor § ij, is an 
excellent application to bed-sores. Burned alum is a mild escharotic, 
which is sometimes used to destroy exuberant granulations. 

Authorities referred to : 

Gubler, Dr. A. Cornmentaires de Tkerapeutigtce, etc., p. 433. 
Nothnagei,, Dr. Hermann. Handbuch der Arzneimittellehre, p. 311. 
Trousseau et Pidoux. Traite de ITierap., etc., vol. i., p. 18S. 
Waldenburg und Simon. Handbuch der Arzneiverordnungs-Lehre, p. 154. 
United States Dispensatory, thirteenth edition. 

Acidum Tannicum. — Tannic acid. Tanin, Fr. ; Tanninum, Ger. 

"Tannic acid has a yellowish-white color, and strongly astringent 
taste. It is decomposed and entirely dissipated when thrown on red- 
hot iron. It is very soluble in water, and less so in alcohol and ether. 
Its solution reddens litmus, and produces, with solution of gelatine, a 
white, flocculent precipitate ; with the salts of the sesquioxide of iron a 
bluish-black precipitate ; a,nd with solutions of the alkaloids white pre- 
cipitates, very soluble in acetic acid." Dose, gr. j — 3 j. 

Glyceritum Acidi Tannici. — Glycerite of tannic acid. (Tannin, 
3 ij ; glycerin., § viij.) 



TANNIC ACID AND VEGETABLE ASTRINGENTS. 273 

Ungucntum Acidi Tannici. — Ointment of tannic acid. (Tannin, 
3ss; lard, f j.) 

Suppositoria Acidi Tannici. — Suppositories of tannic acid. (Tan- 
nin, 3 j ; ol. theobromte, 3 v.) 

Acidum Gallicum. — Gallic acid. Acide Gallique, Fr. ; Gallapfel- 
saure, Gcr. 

" Gallic acid is in small, silk}-, nearly colorless crystals, having a 
slightly acid and astringent taste. It is soluble in one hundred parts 
of cold, and in three of boiling water. The solution reddens litmus, 
and does not produce a precipitate with a solution of gelatine, or of sul- 
phate of protoxide of iron. With solutions of salts of sesquioxide of 
iron, it produces a bluish-black precipitate, the color of which disappears 
when the liquid is heated. It is decomposed by a strong heat, and en- 
tirely dissipated when thrown on red-hot iron." Dose, gr. j — grs. x. 

Glyceritum Acidi Gallici. — Glycerite of gallic acid. (Gallic acid, 
! ij ; glycerin., 3 viij.) 

The following remedies contain a tannic acid, and have physio- 
logical and therapeutical actions due to the presence of this sub- 
stance : 

Galla. — Nutgall. JVbix de galle, Fr. ; Gallapfel, Ger. 

Tinctura Gallce. — Tincture of galls. Dose, 3 ss — 3 ij. 

Unguentum Gallce. — Ointment of galls. (Galls in fine powder, 3j; 
lard, 420 grains.) 

Composition. — Tannic acid (gallo-tannic), 60 to 70 per cent.; gallic 
acid, 3 per cant. ; sugar, resin, etc. 

Catechu. — Catechu. "An extract prepared principally from the 
wood of Acacia Catechu." Cachou, Fr. ; Katechicsafe, Ger. 

Tinctura Catechu. — Tincture of catechu. (Catechu, 3 iij ; cinna- 
mom., §" ij ; diluted alcohol, Oij.) Dose, m. x — 3 j. 

Infusum Catechu Compositum. — Compound infusion of catechu. 
(Catechu, |ss; cinnamon, 3j; boiling water, Oj.) Dose, 3j — 3 ss. 

Composition. — Catechin, or catechuic acid. 

Kino. — Kino. " The inspissated juice of Pterocarpus Marsupium, 
and of other plants." Kino de VInde, Fr. ; Kino Gummi, Ger. 

Tinctura Kino. — Tincture of kino ( 3 yj — Oss). Dose, m. x — 3 ij- 
Composition. — Kino-tannic acid. 

Krameria. — Rhatany. " The root of Krameria triandra." Tiatanhia, 
Fr. ; Ratanhiawurzel, Ger. 

Kxtractum Kramerice. — Extract of rhatany. Dose, grs. v — grs. x. 
19 



274 AGENTS INCREASING WASTE. 

Infusum Kramerice, — Infusion of rhatany ( 3 j — Oj). Dose, § ss — 

n ' 

Extractum Eramerice Fluidum, — Fluid extract of rhatany. Dose, 
m. v — 3 ss. 

Syrupus Eramerice. — Sirup of rhatany. Dose, 3 j — 3 iv. 

Composition. — Ratanhia-tannic acid; odorous principle; wax, gum, 
etc. 

HaBmatoxylon. — Logwood. " The heart-wood of hajmatoxylon Cam- 
pechianum." JBois de Camp&che, Fr. ; Campechehoh, Ger. 

Decoctum Hoematoxyli. — Decoction of logwood. (Logwood, § j ; 
water, Oij, boiled down to Oj.) Dose, § ss — § j. 

JExtractum Ecematoxyli. — Extract of logwood. Dose, grs. v — 3 j. 

Composition. — Hematoxylin, tannic acid, etc. 

Geranium. — Cranesbill. " The rhizoma of Geranium maculatum." 
No official preparations. 

Composition. — Tannic and gallic acids, resin, gum, starch, chloro- 
phyll, etc. 

Quercus Alba. — White-oak bark. 

Quercus Tilictoria. — Black-oak bark. IZcorce de cMne, Fr. ; Eichen- 
rinde, Ger. 

Decoctum Quercus Albce. — Decoction of white-oak (|j — Oj). 
Dose, I ss — 1 j. 

Composition. — Quercitrine or quercitric acid, tannic acid, etc. 

Rosa Gallica. — Red rose. " The petals of Rosa Gallica." Roses 
rouges, Fr. ; JEssigrosen, Ger. 

Confectio Hosce. — Confection of rose. 

Infusum Hosce Compositum. — Compound infusion of roses. (The 
infusion contains 3 iij of diluted sulphuric acid in two and a half pints.) 

Mel Hosce. — Honey of rose. 

Composition. — Tannic and gallic acids, quercitrine, coloring matter, 
volatile oil, etc. 

Rubus. — Blackberry-root. Root of Rubus Canadensis and Rubus 
villosus. 

Syrupus JRubi. — Sirup of blackberry. Dose, 3 j — § ss. 

Aromatic sirup of blackberry, which is not official, contains black- 
berry-root, cinnamon, cloves, and mace. A fluid ounce contains the 
strength of thirty grains of the root. 

Composition. — Tannic acid, etc. 

Myrica Cerifera. — Bayberry, Wax-myrtle (not official). Bark of the 
stem and root. 



TANNIC ACID AND VEGETABLE ASTRINGENTS. 075 

Decoction is made by boiling an ounce in a pint of water — dose 3 ss 
— 3 j. An alcoholic extract [myricine of the eclectics) — dose, grs. v ; 
and a fluid extract — dose, 3 88 — 3 ij — are to be obtained in the shops. 

Composition. — Tannic and gallic acid, myricinic acid, resin, red 
coloring matter, etc. 

The most important property is the astringency due to the large 
quantity of tannic and gallic acids. In large doses it is emetic. 

Statice Limonium. — Marsh rosemary. (Xot official.) The root. A 
decoction ( 3 j — Oj) may be used — dose, 3 ss — 3 j. A fluid extract is 
prepared — dose, m. xx — 3 j- 

Composition. — Tannic acid (twelve per cent.) gum, extract, etc. 

AllluS SeiTulata. — Common alder. (Not official.) The bark in de- 
coction (33 — Oj) — dose, § ss — 3 j. Fluid extract — dose, m. x — 3 j. 
Alcoholic extract (Alnnin of the eclectics) dose, gr. j — grs. v. 

Composition. — Tannic acid, oil, resin, etc. 

Heuchera. — Alum-root. United States Secondary List. Root of 
Heuchera Americana. Decoction — dose, 3 ss— 3 j ; fluid extract — 
dose, m. x — 3 j. (Not official.) 

Composition. — Tannic acid, etc. 

Hamamelis Virginica. — "Witch-hazel. Bark and leaves. Decoction 
( 3 j — Oj) — dose, 3 ss — 3 j. Fluid extract — dose, 3 ss — 3 ij. (Not 
official.) 

Composition. — Tannic acid, odorous matters, etc. 

NymphaBa Odorata. — Sweet-scented water-lily. Root. Decoction 
(33 — Oj) — dose, 3 ss — I j. Fluid extract — dose, 3 ss — 3 j. (Not 
official.) 

Composition. — Tannic acid, gallic acid, etc. 

Castanea Vesca. — Chestnut-leaves. (Not official.) Decoction ( f j 
— Oj) — dose, 3 ss — 3 ij. Fluid extract — dose, 3 j — 3 ij. 
Composition. — Tannic acid, etc. 
(Used more especially as a remedy for whooping-cough.) 

Antagonists and Incompatibles. — The mineral acids, the salts of 
antimony, lead, and silver, and the persalts of iron, and alkalies, are 
chemically incompatible. The vegetable alkaloids and gelatine form 
insoluble precipitates. 

Synergists. — Tonics and bitters, as a rule, favor the action of tan- 
nic and gallic acids, and of the substances containing them. The agents 
comprehended in this group — or remedies whose chief result is to 
increase waste — are synergistic. 



27G AGENTS INCREASING WASTE. 

Physiological Actions. — Tannin has a bitter astringent taste, and 
constringes the mucous membrane. In the stomach it enters into com- 
bination with albumen, and with the pepsin of the gastric juice, Avhich 
it precipitates from its solution. Tannin, therefore, impairs digestive 
power by rendering the pepsin inoperative. It diminishes secretion of 
the mucous membrane by virtue of its power to contract the calibre of 
the vessels, and it restrains peristalsis by its action on the muscular 
layer ; hence the constipating effects which follow its use. If long 
continued in considerable quantity, tannin disorders digestion, sets up 
irritation of the mucous membrane, and gives rise to a febrile state and 
to wasting of the tissues. 

Having such affinity for and coagulating action on albumen, it is ob- 
vious that tannin must diffuse into the blood with difficulty. A part 
undergoes conversion into gallic and pyro-gallic acids in the stomach, 
and in this form is absorbed. Injected into the veins, tannic acid coagu- 
lates albumen, and the results which follow are due to multiple embo- 
lisms. Elimination of tannin takes place by the intestinal canal and by 
the kidneys, in the form of gallic and pyro-gallic acids. 

Therapy. — Catarrh of the stomach, a relaxed state of the mucous 
membrane, acidity, and flatulence, are conditions in which tannic acid 
is useful. It may be given in pill-form with sufficient glycerine to make 
a mass of proper consistence — one drop to four grains. JBcematemesis 
dependent on ulcer of the stomach, or obstructive disease of the liver, 
and not inflammatory in origin, is an indication for tannin. It should 
be given in solution and in a large dose — grs. x — 3 j. Tannic acid is 
an efficacious remedy in diarrhoea, after acute symptoms have subsided, 
in chronic diarrhoea, colliquative diarrhoea, the diarrhoea of phthisis, 
etc. Notwithstanding the chemical incompatibility, combination with 
opium or morphia increases the efficacy of the tannin. As tannic acid 
in large part, at least, escapes conversion into gallic, and passes un- 
changed into the intestine, its action is doubtless chiefly local. Oppol- 
zer advises the following formula in profuse diarrhoea: ]$. Acidi tan- 
nici, 3 ij ; pulv. opii, grs. vj ; sacchari, q. s. M. ft. pulv. no. vj. Sig. 
One every two hours. In>cholera diarrhoea, A. von Graefe prescribed 
a solution of tannic acid in cinnamon-water and mucilage every half- 
hour. For the diarrhoea and intestinal haemorrhage of typhoid fever, 
tannin is one of the most serviceable remedies. According to Stille, 
whose faith appears rather extravagant, there is no more effective rem- 
edy for chronic diarrhoea and chronic dysentery than tannic acid con- 
joined with a milk-diet. 

Various members of this group are used in the above-mentioned 
diseases. Kino has been a favorite remedy in pyrosis, and is also given 
in diarrhoeal diseases. Catechu, in the form of the tincture chiefly, is 
frequently added to prescriptions for diarrhoea, notably to chalk-mixt- 
ure in the diarrhoea of children. Kino is a favorite remedy for the 






TANNIC ACID AND VEGETABLE ASTRINGENTS. 217 

diarrhoea of phthisis, but it is not more efficacious, and is more disa- 
greeable in administration, than tannic acid. Several of tlie indigenous 
remedies mentioned above possess undoubted value in the treatment of 
diarrhceal diseases. A decoction of rubus or geranium, obtained by 
boiling the root in milk (5J — Oj), is an excellent remedy in cholera 
infantum and the summer diarrhea of children. When a nursing 
child passes rather frequent, greenish, and watery stools, and suffers 
with pain and colic at each motion, great relief will be afforded by the 
use of svrupus rubi, or better by the unofficial compound sirup of rubus. 
In the chronic diarrhoea of adults, and in acute diarrhoea after the sub- 
sidence of inflammatory symj>to/n$, the fluid extracts of hamamelis, of 
heuchera, and of statice, may be used with advantage. In hamdteme- 
sis and intestinal hcemorrhage the hamamelis is very effective, owing 
doubtless to the very large percentage of tannin which it contains. 

The comparative merits of tannic and gallic acids may be formular- 
ized as follows : for local effects tannic acid, for systemic effects gallic 
acid is to be preferred. It is true that tannic acid affects remote parts, 
but in order to diffuse into the blood it must first be converted into 
gallic, and hence the systemic actions are really due to the latter. It 
follows that gallic acid should be prescribed when the astringent effects 
on the tissues elsewhere than the intestinal canal are to be produced. 
Gallic acid is an effective remedy for pulmonary and renal hemor- 
rhage. For the former we possess other agents more efficient, but for 
the latter it is more uniformly successful than any other remedy. The 
success of rhatany, which was formerly much used in h&maturia, was 
doubtless due to its tannic and gallic acids. In the ha-morrhagic diathe- 
sis, gallic acid is one of the remedies wdiich may be used with advan- 
tage. Although it cannot be combined with chalybeates, it may be 
given alternately with them. "Whenever haemorrhage occurs in relaxed 
and debilitated constitutions — is passive in character — gallic acid taay 
be combined with ergotine and digitalis : J$, . Acid, gallici, 3 i ; ergotine 
(aq. ex.), digitalis, aa 3j. M. ft. pil. no. xx. Sig. One every four 
J tours. 

As gallic acid has the power to restrain secretion of mucous sur- 
faces, it may be prescribed, experience has shown with good effect, in 
chronic bronchial catarrh. When bronchiectasis exists, the good effects 
of the remedy are by no means conspicuous, but it is very serviceable 
when the bronchial catarrh is the result of the irritation extending 
from disease of the parenchyma of the lungs, or is produced by mitral 
or tricuspid regurgitation, or is the sequel of acute catarrh. In pyelitis 
and p>xjelo-nephritis, gallic acid and the remedies containing it diminish 
the purulent discharge, and retard changes in the mucous membrane. 
It is also a serviceable remedy in catarrh of the bladder. In these 
states, to insure as far as possible its rapid and complete diffusion into 
the blood, it should be given frequentlv and well diluted. As it is solu- 



2?8 AGENTS INCREASING WASTE. 

ble in eight parts of rectified spirit, and, as this solution mixes in all 
proportions with water without precipitation, a spirituous solution 
should be prescribed : $. Acidi gallici, 3 j ; spirit, vini rectif., § j. M. 
Sig. A teaspoonful in sufficient water every four hours. 

Gallic acid has the power to restrain the waste of albumen in cases 
of albuminuria. It is adapted to the acute forms — desquamative ne- 
phritis, the albuminuria following scarlatina, etc., and does not seem, 
according to the author's observation, to check in the least the loss of 
albumen in the chronic forms of albuminuria. Dr. Aitken recommends 
the following formula : R. Acidi gallici, 3 j — 3 ij ; acid, sulphuric, dil., 
3 ss ; tinct. lupuli, 3 i ; infus. lupuli, 3 vj. M. Sig. A tablespoonful 
three times a day. 

The following mixture is very effective in menorrhagia, hematu- 
ria, purpura hemorrhagica, and the hemorrhagic diathesis: B. 
Acidi gallici, 3ss; acid, sulphur, dil., 3j; tinct. opii deod., 3j; inf. 
rosae comp., 3" iv. M. Sig. A tablespoonful every four hours or 
oftener. 

Hillier advises the following prescription for chronic diarrhoea in a 
child of two years : ]J. Acidi gallici, gr. xij ; tinct. cinnamomi comp., 
3 jss ; tincturae opii, m. viij ; aquae carui ad 3 ij. M. Sig. Two tea- 
spoonfuls a dose. 

For the sweating of phthisis the following formula is useful: IJ. 
Acid, gallici, 3 ss ; ext. belladonnas, gr. ij. M. ft. pil. no. x. Sig. 
Two pills at bed-hour. 

In addition to the foregoing internal applications of the vegetable 
astringents, it may be mentioned that a decoction of chestnut-leaves 
(castanea) has been used with much success in whooping-cough. As 
both tannic and gallic acids have been employed with more or less ser- 
vice in this disorder, it is probable that the good effects of castanea are 
really due to the presence in it of these acids. The decoction of cas- 
tanea may be drunk ad libitum, or the fluid extract may be administered 
in drachm-doses. 

External Uses of Tannic Acid and Substances containing it, — 
Dr. B. W. Richardson has proposed a tannin solution, to which he has 
applied the term styptic colloid. It consists of a saturated solution of 
tannin in alcohol (one part to eight) mixed with collodion. This is an 
elegant application to restrain oozing of blood from a large surface, to 
unite incised wounds, to protect lacerated wounds, to remove fetor 
from decomposing animal matter, to change the character of foul 
ulcers, etc. The following formula was proposed by Monsel as a 
hemostatic: R. Acidi tannici, 3j; aluminis, 3ij; aquae rosae, 3 iij. 
M. Sig. For external use as a hemostatic. The official glj-cerite of 
tannin is a neat formula for external application. 

Tannic acid is much employed as an application to the mouth and 
throat in various diseases of these parts. In mercurial salivation an 



TANNIC ACID AND VEGETABLE ASTRINGENTS. 279 

excellent application is a solution of tannin, with honey of roses: IJ. 
Acidi tannici, 3 j ; mel rosae, 3 ij ; aquae, 3 vj. M. Sig. As a gargle. 
Elongated uvula, relaxed palate, and follicular pharyngitis, are effec- 
tively treated by insufflation of tannin, i. e., some finely-powdered tan- 
nin blown over the affected surface with a hand-ball insufflator. EpiS' 
taxis may often be promptly arrested by passing through the nares a 
strong solution of tannin ( 3 ij — 3 iv) by means of a post-nasal syringe 
or nasal douche, or powdered tannin may be blown on the bleeding 
surface by an insufflator. The following is an excellent gargle for the 
more chronic throat-affections: IJ. Acidi tannici, 3 ij ; spts. vini rect., 
3 j ; mist, camphor, ad § x. M. Sig. An astringent gargle. In 
chronic affections of the larynx mucous membrane, and of the vocal 
cords, no inhalation is more frequently serviceable than a solution of 
tannin (grs. x — 3j — § iv) applied by means of the hand-ball or 
steam-atomizer. This treatment is useful in chronic catarrh of the 
fauces, of the larynx, trachea, and bronchi, in ulcerations of the 
pharynx, larynx, and trachea, in bronchiectasis, in pulmonary haemor- 
rhage, gangrene of the lung, oedema of the glottis, croup, and diph- 
theria. 

The following is Druitt's prescription for toothache : IJ . Acidi tan- 
nici, 3j; mastich, grs. x; etheris, § ss. M. Sig. To be applied on 
cotton to a carious tooth. 

Tannin solutions of various strengths (gr. j — grs. x — § j) are used in 
inflammation of the conjunctiva. Hairion advises a strong solution ( 3 j 
— 3iij)) in acute and chronic conjunctivitis, granulations, corneitis, 
chemosis, and pannus. Very remarkable results have been obtained by 
Dr. Hamilton, of Liverpool, in certain diseases of the eye by the appli- 
cation of powdered tannin to the conjunctiva. This method consists in 
dusting over the everted lid finely-powdered tannic acid, using for this 
purpose a small rubber-bag insufflator. He employs this method with 
signal success in " granular ophthalmia, pannus, phlyctenidar or pus- 
tular ophthalmia, chronic granulations, herpes corneal, fascicular cor- 
neitis, and some ulcers of the cornea." This application produces very 
little pain at the moment, and is not followed by any inflammatory 
reaction. 

Tannic acid has limited uses in diseases of the skin. It is an excel- 
lent application, especially in the form of the glycerite, in eczema, im- 
petigo, and intertrigo. The powder dusted on the affected surface is 
serviceable in cases of ulceration of the skin, and promotes the healing 
process in cases of old ulcers. One of the best applications to irritable 
and fissured nipples is glycerite of tannin. 

Chronic otorrhoea and the vulvitis of children are successfully 
treated by application of the glycerite of tannin. The same remedy is 
one of the best injections in gonorrhoea. Solutions of tannic acid of 
various degrees are used in gonorrhoea. Ricord recommends, in obsti- 



280 AGENTS INCREASING WASTE. 

nate cases, after the subsidence of acute symptoms, 3 ss of tannic acid 
in 3 viij of claret wine. This constitutes a serviceable injection in leu- 
corrhcea. Sigmund advises the following in gonorrhoea: $. Acidi tan- 
nici, grs. ij— grs. x; tinct. iodinii, m. v; aqus3, § j. M. Sig. As an 
injection. An infusion or decoction of galls, of oak-bark, of witch-hazel 
(hamamelis), of geranium, of alum-root, or other remedies of the list at 
the head of this article, may be advantageously used in cervicitis, vagi- 
nitis, purulent discharges from the vagina. In these affections the 
glycerite of tannin, and, much better, the powdered tannin, may be 
freely applied to the vaginal canal. The author knows of no more effec- 
tive application in these maladies than tannin and iodoform, or iodo- 
tannin, applied in the dry way, well packed around the cervix uteri. 

A serviceable ointment for hcemorrlioids is the following prescrip- 
tion of Oesterlen: IJ. Pulv. gallae, 3j; pulv. opii, grs. x; ung. plumbi 
subacetat., 3ij ; ung. simplicis, 3 j. M. Sig. Ointment for haemor- 
rhoids. For prolapsus ani in children the glycerite of tannin, powdered 
tannin, or a decoction of the vegetable astringents considered in this 
article, may be used, the mucous membrane being first carefully cleansed 
and then brushed over with the medicament. Ulcers of the rectum and 
anus, fissures of the anus, are very effectively treated by the direct ap- 
plication of the powder of tannin, tannin and iodoform, or iodo-tannin. 
The ulcer must be exposed, if necessary, by the use of the speculum, 
and then the powder be thoroughly applied to the affected surface. 
Trousseau strongly recommends a mixture of the decoction and the 
tincture of rhatany as an injection for the cure of fissure of the anus, but 
the applications above advised are neater and more effective. 

Authorities referred to : 

Hamilton, Robert, F. R. C. S. On the Employment of Tannic Acid in some Diseases 
of the Eye and Eyelids. TJie Practitioner, vol. ii., p. 347. 

Hanbury and Fluckiger. Pharmacographia , pp. 170, 213, 536, et seq. 

Huseman, Drs. August und Theodor. Die Pftanzenstoffe, p. 996, and pp. 1002, 1006, 
1008, et seq. 

Pharmacopoeia of the Throat Hospital. 

PniLLirs, Dr. C. D. F. Materia Medica and Therapeutics, p. 520. 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests. Various 
articles on the indigenous remedies mentioned at the head of this article. 

Ringer, Dr. Sidney. On the Glycerine of Tannin. The Practitioner, vol. i., p. 27. 
Ibid., Handbook of Therapeutics. 

Stille, Dr. Alfred. Treatise on Therapeutics and Materia Medica, fourth edition, 
col. i., article, Vegetable Ast?-ingents. 

Trousseau et Pidoux. Traite de Therap. et dc Mat. Med., huitieme edition, vol. i 
p. 133, et seq., article Medicaments Astringents. 

United States Dispensatory, thirteenth edition. Various articles. 

Waldenburg und Simon. Handbuch dcr Arz?ieiverordnungs. 

Waldendurg, Prof. Dr. L. Die locale Behandlung der Krankheiten der Athmungs. _ 
organe, Berlin, 1872, p. 237, et teq. 



COLCniCUM. 2*1 

Colchicum. — Meadow saffron. Colchique, Fr. ; Zeitlose, Ger. 

Oolchicl Radix. — Colohicum-root. The corm of C. autumnale. 

Colchici Semen. — Colchicum-seed. The seed of C. autumnale. 

Preparations. — 1. Of the root. 

Extract um Colchici liadicis Fluidum. — Fluid extract of colchicum- 
root. Dose, m. ij — m. v. 

Vinum Colchici liadicis. — Wine of colchicum-root. Dose, m. v — 
m. xxx. 

Ext ractum Colchici Aceticum. — Acetous extract of colchicum. 
Dose, gr. ss — gr. ij. 

2. Of the seed. 

Extractum Colchici Seminis Fluidum. — Fluid extract of colchicum- 
seed. Dose, m. ij — m. x. 

Tinctura Colchici. — Tincture of colchicum ( 3 iv — Oij ). Dose, m. 
x — 3j. 

Yinum Colchici Seminis. — Wine of colchicum-seed ( 3 iv — Oij). 
Dose, m. x — 3 j. 

Composition. — Tannic and gallic acids, starch, sugar, gum, a peculiar 
alkaloid, colchicia, or colchicine. Colchicia is easily converted (by 
acids, in long-kept alcoholic preparations) into an isomeric, crystalliza- 
ble body, colchice'in. The amount of the alkaloid contained in the root 
and the seed is said to be not greater than the half of one per cent. 
Colchicia is not crystallizable, but combines with acids to form crystal- 
lizable salts. The conversion, in any of the pharmaceutical preparations, 
of colchicia into colchicei'n, does not appear to impair the therapeutical 
activity. That colchicia or colchicine is the active principle, is proved by 
the fact that the physiological effects of this alkaloid are the same as 
those of the crude drug (Husemann). 

Antagonists and Incompatibles. — Tannic acid, by forming an 
insoluble tannate with the alkaloid, retards but does not prevent its ab- 
sorption. When a lethal quantity has been taken, emetics and purga- 
tives are required, and demulcents may be freely administered. Opium 
and the alcoholic substances antagonize the depression of the heart's 
action. 

Synergists. — Such alkaloids as produce gastro-intestinal irritation 
and depress the action of the heart, e. g., veratria, aconitia, etc., are 
synergistic. Therapeutically considered, emetics, purgatives, alkalies, 
promote the activity of colchicum. 

Physiological Actions. — Colchicum imparts its virtues to water, 
alcohol, and ether. It has a bitter taste, and excites the flow of saliva, 
In small doses it increases the mucus and glandular secretion of the 
stomach and intestines, and probably also of the liver, kidneys, and 
skin. If the dose be large but still medicinal, colchicum produces a 
feeling of epigastric heat, nausea, and vomiting, depression of the circu- 
lation, muscular feebleness, headache. It frequently purges, producing 



282 AGENTS INCREASING WASTE. 

copious, watery stools, and is generally held to increase the discharge 
of biliary matters. It increases the flow of urine, of the solid constitu- 
ents (urea, uric acid, etc.) as well as of the water, and promotes the 
cutaneous transpiration. In toxic doses colchicum produces all of the 
local as well as the systemic effects of an irritant poison, viz. : acute ab- 
dominal pain, profuse watery and choleriform discharges, suppression 
of urine, feeble pulse, cold sweat, coldness of the extremities. The in- 
tellect remains unaffected until carbonic-acid poisoning supervenes. 
The muscular cramps which have been occasionally observed are prob- 
ably due to the great loss of fluid from the system. "When colchicia is 
injected subcutaneous] y, gastro-intestinal inflammation is produced, 
showing that it has a selective action on this tissue. 

Therapy. — Colchicum is indicated when rapid wasting of tissue and 
prompt elimination of the products of waste are required. Its use at 
the present time is almost entirely restricted to the treatment of gout 
in its various manifestations. It relieves the pain, diminishes the swell- 
ing, and shortens the duration of an attack of acute gout. In order to 
accomplish these results, it is not necessary that the more harsh and 
violent physiological effects of the drug be produced. Sufficient quan- 
tity of colchicum should be given to increase secretion from the skin, 
the intestinal mucous membrane and the kidneys, but nausea and vomit- 
ing should be avoided. Combination with an alkali increases the thera- 
peutical effect of colchicum: fy. Spts. ammoniae aromat., 3xiij; vini 
seminis colchici, 3 iij. M. Sig. A teaspoonful every three hours, until 
some physiological effect is produced. The following is a formula used 
at the London Hospital for gout: $. Tinct. colchici seminis, m. xx ; 
potassii bicarbonat., grs. x ; aquae pimentae, Ij. M. Sig. A draught. 
The following modification of Scudamore's prescription is in use at Uni- 
versity College Hospital : I50 . Tinct. colchici seminis, m. xv ; magnesii 
carb., gr. vj ; magnesii sulph., grs. xxx ; aquae menth. pip. ad §j. M ; 
Sig. A draught. After the more acute symptoms of the gouty attack 
have subsided, the following was recommended by Sir Henry Halford : 
IJ. Ext. colchici acet., gr. vj ; pulv. opii et ipecac, comp., ext. colocynth. 
comp., aa gr. xij. M. ft. pil. no. xij. Sig. One pill night and morning. 
The efficiency of colchicum is increased by combination with digitalis : 
1^. Ext. colchici acet., gr. x; pulv. digitalis, ext. colocynth. comp., 5a 
3j. M. ft. pil. no. xx. Sig. One pill twice or thrice a day. 

The active principle, colchicia, is, there is reason to believe, more 
successful in gout than any of the preparations of the crude drug. Tfc. 
Colchiciae, gr. j ; ext. colocynth. comp., 3 ss ; quiniae sulph., 3 iij. M. 
ft. pil. no. lx. Sig. One every four hours. 

In the so-called rheumatic gout, colchicum with alkalies is extreme- 
ly serviceable. Attacks, without decided pain and inflammation, of 
soreness of joints which have been the seat of gouty attacks, or about 
which nodosities have been deposited, are relieved by colchicum. 



COLCHICUM. 883 

Constipation, hepatic congestion, and headache, due to torpor of 
the portal circulation, occurring in gouty subjects, are quickly relieved 
by a combination of colchicum and saline purgatives. The plethoric 
and overfed without being gouty, suffering from the same group of 
symptoms, are relieved by the same means. Inflammations of internal 
organs occurring in gout}' subjects, for example, gouty bronchitis and 
rheumatic pneumonia, are best treated with prescriptions containing a 
preparation of colchicum. The following prescription is recommended 
by Greenhow in gouty bronchitis: IJ. Potassii iodidi, ammonii car- 
bonat., ail 3j ; vin. colchici seminis, 3 j ; tinct. scillas, tinct. hyoscyami, 
ail 3 ij ; aquae camphorae q. s. ad 3 iij. M. Sig. A tablespoonful three 
times a day. 

Although colchicum is still advocated by some authorities in acute 
rheumatism, the general professional experience is against its use. In 
chronic rheumatism, when the joint changes are allied in nature to those 
which take place in gout, it is unquestionably serviceable. Neuralgia 
occurring in gouty and rheumatic constitutions is often relieved by 
colchicum. The indications for its use are plethora, constipation, and 
deficient excretion of the liver, kidneys, and skin. Colchicum relieves 
in such cases, by setting up an eliminative process. In hepatic dropsy 
and cardiac dropsy, when the patient is vigorous, the gastro-intestinal 
tract free from inflammatory mischief, colchicum may be used with ad- 
vantage as a hydragogue : IJ, . Elaterii, gr. j ; spts. etheris nitrosi, § ij ; 
tinct. scillae, tinct. colchici, aa § ss ; syrp. simplicis, § j. M. Sig. A 
teaspoonful three or four times a day. The following combination is 
an excellent diuretic in dropsy : $ • Vini seminis colchici, § ss ; sol. am- 
monii acetat., 3 ijss ; inf. petroselin, § v. M. Sig. A tablespoonful 
every four hours. This prescription is well adapted to dropsy follow- 
ing scarlatina. 

Colchicum is a serviceable remedy in certain cerebral disorders. 
Thus, it may be used in acute cerebral congestion in plethoric subjects, 
in uraimic intoxication, in hypochondriasis, especially when due to de- 
ficient elimination (uric acid, oxalate of lime, etc.). 

The wine of colchicum-seed has frequently succeeded in curing 
gonorrhoea, and by Brodie a nightly dose of thirty minims was given 
for the relief of chordee. In the treatment of gonorrhoea, the following 
may be used: IJ . Vini colchici seminis, | ss ; sol. potassii citratis, §vjss; 
tinct. opii deod., 3 ij. M. Sig. A tablespoonful three or four times 
a day in gonorrhoea. 

Authorities referred to : 

Brodie, Sir Benjamin. Works by Mr. Hawkins, Diseases of Urinary Organs, vol. ii. 
Caspar, Johann Ludwig. Praclisches Handbuch der gerichtlichen Medicin. Neu 
bearbeitet und vermehrt von Dr. Carl Liman, Berlin, 1871, p. 570. 

Fuller, Dr. William Henry. On Rheumatism, Rheumatic Gout, etc., 1874. 
Greenhow, Dr. E. Headlam. Chronic Bronchitis, etc. 



2S4 AGENTS INCREASING WASTE. 

GriBLER, Dr. Adolphe. Commentaires du Codex Medicamentarius, etc., article Col- 
chique. 

Hanbcrt and Fluckinger. Pharmacographia, p. 636. 

Hammond, Dr. W. A. The American Journal of the Medical Sciences, January, 1859, 
p. 278. 

Husemann, Drs. Theo. and Aug. Die Pfianzensloffe, p. 493, article Colchicni. 

Stille, Dr. Alfred. Therap. and Materia Medica, fourth edition, vol. ii., p. 658, et 
seq. 

United States Dispensatory, thirteenth edition, article, Colchicum. 

Sarsaparilla, Sarsaparilla. — Root of smilax officinalis and other spe- 
cies of smilax. Separeille, Fr. ; Sarsaparillwurzel, Ger. 

Decoctum Sarsaparillce Co?npositum. — Compound decoction of sar- 
saparilla. (Sarsaparilla, sassafras-root, guaiacum-wood, liquorice-root, 
mezereon.) Dose, f j — f iv. 

Extractum Sarsaparillce Fluidurn. — Fluid extract of sarsaparilla. 
Dose, 3 j — § ss. 

Syrupus Sarsaparillce Compositus. — Sirup of sarsaparilla. (Sarsa- 
parilla, guaiacum-wood, rose, senna, liquorice-root, essential oils.) Dose, 
3 j— § ss. 

Extractum, Sarsaparilla? Compositum Fluidurn. — Compound fluid 
extract of sarsaparilla. (Sarsaparilla, liquorice-root, sassafras, meze- 
reon.) Dose, 3 ss — 3 ij. 

Composition'. — An alkaloid, parilline, or smilacine, an essential oil, 
starch, resin, oxalate of lime, and extractive matters. From parilline, 
by the action of dilute sulphuric acid, is obtained parigenine, a distinct 
alkaloid. 

Antagonists and Incojipatibles. — Alkalies favor the decomposi- 
tion of the decoction and fluid extracts. As there is much starch pres- 
ent in the drug, free iodine should not be prescribed with the officinal 
preparations. 

Synergists. — Iodine, mercury, and other so-called alteratives, in- 
crease the therapeutical activity of sarsaparilla. Warm clothing in- 
creases the action on the skin ; diluents favor increased urinary dis- 
charge. 

Physiological Actions. — Much discrepancy obtains in the opin- 
ions which have been emitted in respect to the physiological actions of 
sarsaparilla. Surgeons generally hold to its therapeutical powers ; 
physicians are skeptical. The physiological experiments which have 
been made, both with the preparations of the crude drug and with the 
alkaloid, have yielded negative results. Palotta's experiments, made 
with the alkaloid which he had discovered so long ago as 1825, indicate 
that eight grains of the alkaloid produce gastric disturbance, vomiting, 
slowing of the pulse, depression, faintness, and sweating. These re- 
sults have since been in part confirmed by Cullerier. Boecker, how- 
ever, making more systematic examination in accordance with modern 



GUAIACUM. 2Q5 

methods, finds that sarsaparilla is devoid of physiological activity and 
of therapeutical power (Husemann). 

Therapy. — From the point of view of the physiological experi- 
ments it is not difficult to understand, the modern incredulity in regard 
to the curative power of sarsaparilla. The difficulty of distinguishing 
between the post hoc and the propter hoc serves to account for the 
belief still held in some quarters, that this drug is an alterative. Popu- 
larly, sarsaparilla is supposed to have extraordinary powers as a " blood- 
purifier," and its large use at the present time arises from this belief. 

Almost the only use of sarsaparilla at the present time is in the 
treatment of syphilis. It is, of course, not adapted to the primary or 
to the secondary forms. The experience in its favor, even of those 
most confident of its powers, restricts its use to the tertiary form in de- 
bilitated subjects, who have been broken down by the combined influ- 
ence of syphilis, mercurialism, and iodism. It has been further demon- 
strated that the best effects have been obtained by the use of large 
doses of the compound decoction (Allbutt). As the compound de- 
coction contains guaiac and mezereon, it is difficult to assign the exact 
share of the sarsaparilla in the result. Furthermore, as a pint or more 
Df the compound decoction must be taken in the twenty-four hours, 
these large draughts of a warm liquid are not without influence on the 
functions of the skin and kidneys. It is extremely questionable whether 
sarsaparilla has any therapeutic power ; it is not at all equal as an 
alterative to some of the remedies indigenous in the United States, to 
be considered hereafter. 

The compound fluid extract, the compound decoction, and the com- 
pound sirup of sarsaparilla, are frequently used as vehicles for iodide 
of potassium and for the bichloride of mercury in secondary and ter- 
tiary syphilis. 

Scrofula, chronic abscesses, necrosis of bones, old ulcers, and stru~ 
mous cutaneous affections, are diseases in which sarsaparilla is sup- 
posed to be efficacious. It is more used as an adjunct to more active 
remedies than depended on alone. 

Authorities referred to : 

Allbutt, Dr. Clifford. The Practitioner, 1ST0, vol. i. 

Gubler, Dr. Adolphe. Commentaires Therap. du Codex Medicamentarius, p. 304. 

Haxbury and Fltjckiger. Pharmacographia, p. 636, et seq. 

Husemann, Drs. Aug. und Theodor. Die Pflanzenstoffe, p. 1040. 

Guaiacum. — Guaiac. Gayac, Fr. ; Franzosenholz, Ger. 

Guaiaci Lignum. — Guaiacum-wood. The heart-wood of guaiacum 
officinale. 

Ouiaci Resina. — Guaiac. A peculiar resin obtained from guaiacum 
officinale. 



286 AGENTS INCREASING WASTE. 

Tlnctura Guaiaci. — Tincture of guaiac. (Guaiac, § vj ; alcohol, 
Oij.) Dose, 3 ss — 3 ij. 

Tlnctura Guaiaci Ammoniata. — Ammoniated tincture of guaiac. 
(Guaiac, § vj ; aromat. spirit of ammonia, Oij.) Dose, 3 ss — 3 ij. 

Composition. — The only constituent of interest in the wood is the 
resin. Guaiac has a complex chemical composition. It contains guaia- 
conic acid (seventy per cent.), guaiarec acid, guaiac beta-resin, guaiacic 
acid, guaiac yellow, gum, etc. 

Antagonists and Incompattbles. — Spirits of nitrous ether and the 
mineral acids are incompatible. 

Synergists. — Agents which promote cutaneous activity are syner- 
gistic. The action of guaiac is much aided by external warmth and 
warm diluent drinks. 

Physiological Effects. — Guaiac has a very acid and pungent taste. 
It excites an abundant flow of saliva. In the stomach it creates a sen- 
sation of warmth and burning, increases the secretions of the gastro- 
intestinal canal, accelerates the action of the heart, promotes diapho- 
resis, and favors the production and excretion of bronchial mucus. In 
large doses it deranges digestion and causes gastric catarrh, and in ex- 
cessive doses the series of symptoms produced by the irritant poisons, 
vomiting, purging, cramps, headache, giddiness, etc. 

Theeapy. — Formerly guaiac was in great repute as a remedy for 
constitutional syphilis. The decoction was drunk in large quantity, a 
very spare diet was enjoined, and the diaphoretic action of the remedy 
was aided by external warmth. Doubtless many cases were benefited 
by this mode of treatment, but the result was probably less due to 
guaiac per se than to the regimen. 

Its present use as an anti-syphilitic remedy is confined to the prepa- 
rations of sarsaparilla, in which it enters as a constituent. 

Recent clinical experience has shown that guaiac is a capital remedy 
in tonsillitis. Given in a half-drachm dose (tincture) every four hours, 
it appears to abate the inflammation and to cut short the disease in a 
remarkable manner. It is a very acrid and disagreeable remedy, and 
should be given in emulsion, with mucilage or yolk of egg. 

Guaiac is a useful remedy in dysmenorrhea, when the pain is due 
to rheumatism or neuralgia, and is, of course, not adapted to those cases 
in which there is narrowing of the cervical canal. 

Lastly, guaiac is used with varying degrees of success in chronic 
gout, chronic rheumatism, lumbago, sciatica, gouty bronchitis, etc. As 
we have so many more efficient and pleasant remedies for these dis- 
eases, it will rarely be necessary to resort to guaiac. 

Authorities referred to : 

Carter, Mr. The Practitioner, voL iv., p. 190. 
Fluckiger and Hanbury. Pharmacographia, p. 92, et seq. 



STILLINGIA. 287 

Hcskmas.v, Drs. Aco. cnd TnEO. Die PJlanzenstoffc, p. 712. 

Stille, Dr. A. Therapeutics and Materia MeJica, fourth edition, vol. ii., p. 694. 

United States Dispensatory, thirteenth edition, p. 439, el seq. 

Stillingia. — Moot of Stillingia Sylvatica. Yaw-root, queen's root. 

Extractum Stillingice Fluidum. — Fluid extract of stillingia. Dose, 
oi. x— 3 j. 

(The above is the only preparation recognized by the United States 
Pharmacopoeia. A tincture may be made of two ounces of tbe bruised 
root to a pint of diluted alcohol, of which the dose is 3 ss — 3 ij. A 
decoction may be made as follows : one ounce of the bruised root to 
two pints of water, boiled down to one pint, of which the dose is 
3 ss — 3 ij. All of the preparations should be made of the fresh root, 
as the activity of the drug is diminished by drying.) 

Composition. — The plant yields on incision a milky juice, which ap- 
pears to possess the medicinal properties of the drug. The so-called 
etUlingin of the eclectics is not the active principle, but an extract. 
The active principle has not yet been isolated. 

Physiological Effects. — The juice of the plant has an acrid, pun- 
gent taste, leaving a persistent after-taste of great activity. It excites 
an abundant flow of saliva. In the stomach a feeling of warmth fol- 
lows its use, and the secretions of the organ are increased in amount. 
In full doses it excites nausea and vomiting, epigastric pain, and an 
acrid, burning sensation in the fauces. It increases the secretions of 
the intestinal canal, notably of the liver, and, in full doses, purges, the 
faeces having the appearance of the so-called " bilious stools." Increased 
action of the heart follows the introduction of the active principle into 
the circulation, and the skin becomes warm and moist. The bronchial 
mucous membrane exhales a larger quantity of mucus, and the kid- 
neys become more active, excreting an increased quantity of water and 
solids. It may, therefore, with propriety be grouped with the so-called 
alteratives. 

Therapy. — Stillingia is certainly a very valuable remedy. It has 
long had a local reputation in the Southern Atlantic States as an al- 
terative. 

In habitual constipation, due to deficient secretion of the intestinal 
mucous membrane, it may be used with advantage. The torpidity of 
the liver and jaundice, which follow attacks of intermittent fever, are 
removed by stillingia. This agent, also, renders important service in 
the first stage of cirrhosis, and in ascites due to the hepatic changes. 
Scemorrhoids, when due to obstructive difficulty in the liver, may be 
removed temporarily, and, if due to constipation, may be removed per- 
manently, by stillingia. 

In habitual constipation the following formula is useful: IJ. Ext. 
6tillingiae fl., 3 v ; tinct. belladonnas, tinct. nucis vom., tinct. plrysostig- 



283 AGENTS INCREASING WASTE. 

matis, aa, 3 j. M. Sig. Twenty drops, in water, three times a day be- 
fore meals. When the biliary secretion is deficient, the following : JjL 
Ext. stillingia? fl., 3 v ; tinct. aloes, 3 ij ; tincfc. nncis vom., 3 j. M. Sig. 
Twenty drops, in water, three times a day. 

Stillingia has leng been in popular repute as a blood-purifier. It 
has been used in domestic practice as a remedy for scrofula in its vari- 
ous forms, and the success which has attended its employment justifies 
the high encomiums which have been bestowed on it. It is very ser- 
viceable in children who present the following symptoms : enlarged cer- 
vical glands, muco-purulent discharge from the nose, with excoriations 
of the surrounding integument, a pasty complexion, capricious and 
unnatural appetite, tumid abdomen, whitish and pasty stools / dull-red, 
soft, and tubercular eruption on the shin, ulcerating and furnishing a 
large quantity of unhealthy pus. The steady use of stillingia, com- 
bined with suitable hygienic means, will accomplish important relief in 
such cases. 

The most satisfactory results have been obtained from the use of 
stillingia in syphilitic affections. It is applicable to the same condi- 
tions under which the preparations of sarsaparilla are now used, viz. : 
in chronic cases of the secondary and tertiary form, the patients having 
been broken down by the long-continued use of mercurials and iodides. 
Repeated observation of cases in which it was used as the sole agent 
has satisfied me of its curative value. It differs from the compound 
decoction of sarsaparilla in this, that its effect is distinctive, and is not 
due to the use merely of a large quantity of fluid. The eminent Dr. 
Porcher, of South Carolina, thus expresses himself with regard to the 
use of stillingia in syphilitic affections : " I have employed the decoc- 
tion of the root of this plant as an alterative in syphilitic sores, occur- 
ring in patients in the City Hospital, Charleston, the spread of which 
nothing else could arrest. It proved completely satisfactory. Phage- 
denic chancres were rapidly cured under its use. A strong decoction 
was given three times a day, with four drops of nitric acid to each 
dose." 

A strong infusion or decoction of stillingia is said to be effective in 
preventing the development of a paroxysm of ague, if taken before or 
just as the chill is beginning. It is reported that profuse diaphoresis 
is produced and the impending attack is averted. The fluid extract of 
stillingia may be given in combination with quinia or arsenic in inter- 
mittents. 

Authorities referred to : 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, Charles 
ton, 1869, p. 146. 

United States Disi;ensatcrt, thirteenth edition, p. 838. 



SANGUINARIA. ggg 

Sanguinaria. — Blood-root. The rbizoma of Sanguinaria Canadensis. 

Tliictura Sanguinarm. — Tincture of sanguinaria. Dose, m. v — 
3ss. 

Composition. — Sanguinaria contains an alkaloid, sanguinarma, 
which appears to be identical with the chelerythrin of Probst. " San- 
srumarina is a white, pearly substance of an acrid taste, v.ery sparingly 
soluble in water, soluble in ether, and very soluble in alcohol. With 
the acids it forms salts soluble in water, all of which have some sbade 
of red, crimson, or scarlet, and form beautiful red solutions." Another 
alkaloid, named 2'>or})hyroxine (sanguinaria-porphyroxin — ITuscmann), 
has been found by Riegeh, and a third, puccin, so called by Wayne, 
is not genuine. Besides these alkaloids, sanguinaria contains a pe- 
culiar acid, cheliclonic, and another has been announced, for which 
the name sanguinarinic acid has been proposed. The alkaloids exist 
in the root in combination with these acids — the most important com- 
pound being the chelldonate of sanguinarina. Besides the foregoing, 
blood-root contains the following unimportant constituents : resin, gum, 
extractive, albumen, sugar, etc. 

Antagonists and Incompatibles. — Alkalies, tannic and gallic 
acids, and most of the metallic salts, are chemically incompatible with 
the preparations of blood-root. The local irritant action of the drug 
and the depression of the circulation w T hich it causes are antagonized 
by opium. 

Synergists. — The mineral and vegetable emetics, the so-called alter- 
atives of the vegetable kingdom, and the mineral salts, considered 
from the therapeutical point of view, promote the physiological and 
therapeutical effects of sanguinaria. 

Physiological Effects. — Sanguinaria has a bitter, acrid taste, 
which persists for a long time. When swallowed it leaves a sense of 
constriction and acridity in the throat. It excites a feeling of heat in 
the stomach, and increases secretion of the mucous membrane. If the 
quantity taken is insufficient to produce nausea the action of the heart 
is increased, and a subjective sensation of warmth is experienced 
throughout the system. In considerable doses sanguinaria is an active 
emetic, producing much nausea and depression, and slowing the action 
of the heart. It is very irritating to the mucous membrane. Snuffed 
up the nose it produces violent sneezing. In large doses it inflames 
the stomach, producing intense burning with thirst, great prostration, 
dimness of vision, vertigo, and collapse. 

The alkaloid, sanguinarina, manifests all the physiological capabil- 
ities of the drug. It has an intensely bitter, acrid taste. In small 
.doses (one-twelfth to one-eighth of a grain) it simply increases secre- 
tion of the gastro-intestinal mucous membrane ; in doses of one-sixth to 
one-fourth of a grain it causes depressing nausea and sometimes vomit- 
ing. In large doses it produces, in addition to the gastric symptoms 
20 



290 AGENTS INCREASING WASTE. 

mentioned above, slowing and irregularity of the pulse, cold sweats, 
cold extremities, vertigo, dilated pupils, anxiety, etc. 

Applied to fungous granulations, sanguinaria has considerable escha- 
rotic power. 

The sketch above given of the physiological actions of sanguinaria, 
which embodies the results of the author's investigations and clinical 
studies, requires no ' special modification. The recent elaborate and 
most thorough research of Dr. Robert Meade Smith confirms the author's 
account. The reader who wishes to exhaust the subject will find that 
nothing has been omitted by Dr. Smith. 

Theeapy. — In atonic dyspepsia from two to five drops of the tinct- 
ure, or the one-twelfth of a grain of sanguinarina, may be used with 
advantage. It promotes secretion, and increases the appetite. There 
seems no doubt, according to the author's observation, that sanguinaria 
promotes the hepatic and intestinal secretions. It is, therefore, a ser- 
viceable remedy in duodenal catarrh, and secondary catarrh of the 
biliary ducts with jaundice. 

Its most important therapeutical effects are witnessed in diseases of 
the respiratory organs. Chronic nasal catarrh is successfully treated 
by the internal use of the tincture (ten drops ter die), or of the alkaloid 
(one-fifteenth of a grain ter die), and the local application of the pow- 
der, in small quantity, applied by an insufflator to the Schneiderian 
mucous membrane. In acute bronchitis (catarrh), after the subsidence 
of the more acute symptoms, it is a serviceable expectorant. It may 
be combined with other expectorants and alterants : IJ . Tinct. sangui- 
narise, 3 j ; tinct. lobelias, 3 j ; vini ipecac, 3 ij ; syrp. tolutan., ? ss. 
M. Sig. A teaspoonfid, every three hours, as an expectorant. In 
humid asthma the following combination is extremely serviceable : IJ . 
Tinct. sanguinaria?, 3 j ; tinct. lobelia?, 3 j ; ammonii iodidi, 3 i ; syrp. 
tolutan., 3 vj. M. Sig. A teaspoonful every two, three, or four hours. 
In spasmodic asthma the same prescription is occasionally very effect- 
ual, but the author is unable to indicate the precise condition under 
which it is most useful. 

Sanguinaria has been proposed as an emetic in croup. It is, how- 
ever, too uncertain in action, and too harsh, to justify its use when 
there are so much more eligible remedies at hand. 

The emmenagogue properties of sanguinaria seem well established. 
It is indicated when amenorrhcea is functional in character, when there 
is an absence of plethora, and when no malformation exists. It may 
be advantageously combined Avith aloes, provided there is no contra- 
indication to the use of the latter. R . Tinct. sanguinaria?, 3 ij ; tinct. 
aloes, | ss ; tinct. nucis vom., 3 ij. M. Sig. Twenty drops, two or 
three times a day, in amenorrhoea of anaemia, or chlorosis. Or the 
following: r£. Sanguinarina?, grs. ij; ext. aloes, grs. x; ferri redacti, 
3j. M. ft. pil. no. xx. Sig. One pill three times a day. 



XANTHOXYLUM. 291 

Sanguinaria lias decided aplircdisiac properties. When there are 
relaxation of the genital organs, diurnal losses, inaptitude (from irrita- 
bility) for coitus, sanguinariiia may be given as follows : I£ . Ergotin (aq. 
ex.), 3j; sanguinarinse, grs. jj. M. ft. pil. no. xx. Sig. One, three 
tunes a day. As stillingia appears to have similar properties as an 
aphrodisiac, the following combination will prove useful: I£. Tinct. 
sanguinaria 1 , 3 il j ; ext. stillingiae fl., 3 v. M. Sig. Fifteen to twenty 
droj>s, in water, three times a day. 

As an alterant in chronic syphilitic and strumous affections, san- 
guinariiia may be used in the same class of cases as sarsaparilla, guaiac, 
and stillingia. It is an important addition to a decoction of woods in- 
digenous to our soil, used as a substitute for the more expensive and 
really less efficient foreign drugs of the same group. 

Local Applications. — Sanguinaria, having feeble escharotic prop- 
erty, is used as a local application to repress exuberant gramdations, 
and to ill-conditioned ulcers to change their character. Several cases 
have been reported, indicating the power of sanguinaria to repress the 
growth and destroy nasal polypi. 

A decoction of sanguinaria is a useful gargle in the sore-throat of 
scarlatina. 

Authorities referred to : 

IIuseman'n, Drs. Aug. und Tiieo. Die Pflanzenstoffe, p. 199. 

Toucher, Dr. Francis Petre. Resources of the Southern Fields and Forests, p. 31, 
et seq. 

PniLLirs, Dr. C. D. F. Materia Medica and Therapeutics, London, 1874, p. 143. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, fourth edition, vol. ii., p. 454. 

Smith, Dr. Robert Meade. The Physiological Action of San</uinarina. The Am. 
Jour. Med. Sci., October, 1876, p. 346, et seq. 

United States Dispensatory, thirteenth edition, p. 769. 

Xanthoxylum. — Prickly ash. The bark of Xanthoxylum fraxineum. 
United States Pharmacopoeia, secondary list. 

There are no official preparations of xanthoxylum. A decoction 
may be made by boiling an ounce of the bark in a quart of water down 
to one pint, and of this one to two ounces may be used every four 
hours. A tincture may also be prepared "with two ounces of the root to 
a pint of diluted alcohol, of which the dose would be 3 ss — 3 ij. A 
fluid extract is prepared, and is more frequently in use ; the dose of this 
is m. xv — 3 ij. In prescriptions it should be designated " Mctractum 
xa n th oxyli flu idu m . " 

Composition. — Xanthoxylum contains a neutral crystallizable prin- 
ciple, which is known as xanthoxylin, and is said to be identical with 
xanthopicrite, and the latter has been shown to be berberina. Besides 
this important constituent, a volatile and a fixed oil, resin, gum, etc., 
are contained in it. 

Physiological Actions. — The taste of xanthoxylum is at first 



292 AGENTS INCREASING WASTE. 

sweetish, and somewhat aromatic, but considerable bitterness is soon 
developed, followed by acridity, which remains long in the fauces. It 
has remarkable sialagogue property, and the increased flow of saliva 
occurs from the systemic effects, as well as the local impression on the 
mucous membrane of the mouth. In the stomach it excites a sensation 
of warmth, and increases secretion from the stomach and intestinal 
mucous membrane. It is in a high degree probable that just as its 
presence in the mouth causes salivation, so its presence in the intes- 
tinal canal determines the flow of gastric, duodenal, hepatic, and pan- 
creatic secretion. The action of the heart is increased by xanthoxylin, 
the arterial tension rises, the capillary circulation becomes more ener- 
getic, and the sweat-glands are made to pour forth a more abundant 
secretion. Corresponding effects are produced in the kidneys, and in- 
creased flow of urine follows its administration. 

Therapy. — Xanthoxylum is a domestic remedy for toothache. The 
bark, chewed, has a popular reputation for paralysis of the tongue. A 
decoction of the bark is an efficient local application to the throat when, 
in cases of chronic pharyngitis, there is dryness of the mucous mem- 
brane. From ten to thirty minims of the fluid extract, or a half to one 
drachm of the tincture, is a successful remedy for an extremely obsti- 
nate affection, namely, chronic pharyngitis — the mucus adhering in 
large, thin, dry scales, and the mucous membrane being glossy, shining, 
glazed, and dry. 

The active principle (xanthoxylin, really berberia) is a useful sto- 
machic tonic in atonic dyspepsia. When, however, in stomach, intestinal, 
or hepatic disorders the object is to promote secretion, the preparations 
of xanthoxylum must be used. Jaundice due to catarrh of the bile- 
ducts, and that form of jaundice produced by acute malarial poisoning, 
are conditions in which xanthoxylum is distinctly remedial. Constipa- 
tion, due to deficient secretion, is also removed by this agent. ■ 

Xanthoxylum has long had a deserved reputation in the treatment 
of chronic rheumatism. It is adapted to muscular rheumatism, myal- 
gia, and such local muscular disorders as torticollis (recent cases), lum- 
bago, etc. It may be used with advantage, locally, in these affections. 
The curative power which it possesses in chronic rheumatism is doubt- 
less due to its eliminant action on the mucous and cutaneous surfaces. 

Xanthoxylum is a remedy for constitutional syphilis of equal merit 
with guaiac, mezereon, stillingia, etc., and is greatly more effective than 
sarsaparilla. 

Decoction of xanthoxylum has been used with success in the treat- 
ment of dropsy. 

Authorities referred to : 

Husemann, Drs. Aug. und Theo. Die Pflanzemtoffe, pp. 80, 111, 1108. 
Porcher, Dr. F. Peyre. Resources of the Southern Fields and Forests, p. 161. 
United States Dispensatory, thirteenth edition, p. 900. 



ELECTRICITY. 29.] 



AGENTS USED TO MODIFY THE FUNCTIONS OF 
THE NERVOUS SYSTEM. 

In this division of remedies, the agents are employed with a view 
to their influence over the functions of the nervous system. They do 
not for the most part affect the function of nutrition ; they do not enter 
into the formation of tissues; and, having modified the functions of the 
nervous system, they are excreted from the organism in the form in 
which they entered it. 

The different parts of the nervous system are so closely united in 
function that a disturbance at any point is differentiated to other and 
often widely-separated points, and the complexus of effects is made up 
of many minor disturbances. For this reason it is quite impossible, in 
the present state of our knowledge, to make a classification which will 
sharply define the limits of activity of an}' particular remedy. Never- 
theless, physiological experiment and clinical experience have furnished 
us sufficiently accurate information with regard to the most important 
actions of the remedies of this division, to justify an arrangement based 
on their most conspicuous qualities. 



AGENTS WHOSE MOST IMPORTANT QUALITY CONSISTS IN EXCIT- 
ING FUNCTIONAL ACTIVITY. 

A.— OF THE SPINAL CORD AND SYMPATHETIC. 

Electricity. — Electricity Fr. ; Electricitdt, Ger. 

Forms of Electrical Force employed in Medical Practice. — Static 
or frictional electricity, galvanic, faradic (electro-magnetic, magneto- 
electric). 

Static or frictional electricity is obtained by friction from glass, as 
in the cylinder, plate, or Holz electrical machine. The last-named in- 
strument is best adapted for medical use. The prime conductor of the 
electrical machine furnishes positive or vitreous electricity, and the rub- 
ber, negative or resinous. Various modes of electrization by. static 
electricity are resorted to : 

1. By sparks. In this mode the part to be acted on is made to re- 
ceive sparks from the machine in action. 

2. The electric bath. The patient is placed on an insulated stool, 
and is charged with positive or negative electricity from the prime con- 
ductor, or rubber, according as he is in connection with either. Sparks 
may be drawn from the affected part by presenting the knuckles or a 
metallic conductor. A sharp, tingling sensation, followed by redness 



294 EXCITO-MOTORS. 

and wheals, is produced by sparks, whether received from the machine 
or drawn from the body. 

3. By the Leyden-jar. In this method the electric^ is condensed 
in the Leyden-jar, and the charge is transmitted through the part of 
the body to be acted on. 

Galvanism. — In general terms it may be stated that all chemical 
action is accompanied by electrical phenomena. In its simplest form 
a galvanic battery consists of two elements, zinc and copper, zinc and 
platinized silver, or zinc and carbon, for example, and an exciting fluid. 
The greater the difference in the chemical action of the exciting fluid 
on the two metals, the stronger the galvanic current. The current 
starts from the surface of the oxidizable metal — from the zinc of any 
of the above combinations — -and passes through the exciting liquid to 
the copper, platinized silver, or carbon. This is known as the positive 
current. There is, also, a current which passes in the opposite direc- 
tion — the negative / but, in order to prevent confusion, the positive is 
alone considered. The circuit is said to be closed when the two metals 
are brought directly into contact, or through the intermediation of a 
connecting or conjunctive wire. While, in any of the combinations of 
elements above given, the zinc is the positive metal, it forms the nega- 
tive or — pole, because the current passes from the zinc to the cop- 
per or carbon element in the battery, and from the copper or carbon 
element to the zinc, through the conjunctive wire. A battery is a com- 
bination of elements, and may consist of any number of elements — for 
medical purposes from ten to one hundred, or more. The quantity of 
electricity is the same at all points in the circuit, and depends on the 
amount of chemical action taking place in the battery. Intensity de- 
pends on the number of the elements. According to the law of Ohm, 
the intensity of a galvanic current is in inverse ratio to the resistance 
of the circuit. 

Various forms of batteries are used in medical practice. The most 
suitable are the modification of Daniell's battery, by Remak, known as 
Siemens and Halske's, Smee's zinc and platinized silver, Stcihrer's zinc- 
carbon, Hill's zinc and copper, Muirhead's, ■ Daniell's, Gaiffe's chloride 
of silver, or Grenet's sulphate of mercury. Of these, the best perma- 
nent batteries are Siemens and Halske's elements and Hill's, and the 
best portable battery Stohrer's zinc-carbon combination. The following 
are the requisites of a good galvanic battery for medical use : It should 
be truly constant ; that is, it should furnish a current of uniform volume 
and tension, and not be subject to great fluctuations, rapidly rising to 
the maximum and then as suddenly sinking to zero. It should require 
but little attention to keep it in order. It should be worked with facil- 
ity. The elements of Siemens and Halske, with a suitable pole or key- 
board to work the battery, make an arrangetnent which more nearly 
fills the requirements of a medical battery than any other. 



ELECTKICITY. 095 

Faradism. — This form of current differs from the preceding in tliat 
it is an induced current, and passes in both directions, and has very high 
tension. The apparatus of a faradic instrument (electro-magnetic) 
consists essentially of one or two cups, connected by a conjunctive coil, 
transmitting an inducing current, a secondary coil in which the induced 
current is excited, and a rheotome or current-breaker. The current- 
breaker interrupts the current in the primary coil. So long as the in- 
ducing current passes uninterruptedly, an induced current is not ex- 
cited ; at the moment of opening and closing the circuit, however, an 
instantaneous current is produced, on closing the circuit in a direction 
contrary to that in the conjunctive coil of the batten-, and on opening 
the circuit in the same direction. The induced current is therefore a 
to-and-fro current. 

The faradic instruments ordinarily in use furnish both a primary 
and secondary current. 

The magneto-electric differs from the electro-magnetic in that a cur- 
rent is induced in the secondary coil by magnetism. By a mechanical 
arrangement, a coil of fine wire is made to revolve rapidly about the 
poles of a permanent magnet. As the galvanic current induces a mag- 
netic condition of the bundle of wires which forms the core of the in- 
duction-coil, so the magnetic current of a permanent magnet induces an 
electric state of the insulated wire of the temporary magnet which is 
made to revolve about it. The principle of the two batteries is the 
same as regards the induction of an electric current, the inducing cur- 
rent being in the one case galvanism, and in the other magnetism. 

Phtsiological Effects of Galvaxism. — Electro-pbysiology has 
not contributed very greatly to serve as a foundation for electro-thera- 
peutics. Nevertheless, some attention must be paid to the facts of 
electro-physiology, in so far as they may be utilized to explain the re- 
sults obtained b} 7 the empirical employment of electricity. 

The conductivity of the tissues depends upon the quantity of fluid 
which they contain. Bones and ligaments conduct, therefore, much 
less perfectly than muscles, and muscles more actively than nerves. 
The skin offers a strong resistance to the passage of the electrical cur- 
rent, and hence the utility of moistened electrodes. The current does 
not, as is commonly supposed, pass in right lines, but takes various 
curves, determined by the relative conductivity of the tissues and the 
degree of resistance. 

Notwithstanding the brain is incased in a bony envelope, it has been 
conclusively shown that a galvanic current, applied to the exterior of 
the skull, does traverse the brain. The deepest parts of the body 
may be brought within the circuit. The faradic current does not have 
the power of diffusion and penetration possessed by the galvanic. It is 
not easy to localize the galvanic current to the parts between the poles 
or electrodes. Thus, when one electrode is placed on the nape of the 



29G EXCITO-MOTORS. 

neck, and the other on the sacrum, and a strong current is sent through 
the spine, a metallic taste is experienced in the mouth, and flashes of 
light appear before the eyes, due to the diffusion of the current and 
the excitation of the gustatory and optic nerve respectively. It is 
true these remote effects of the current are sometimes explained by the 
term reflex, but the phenomena are really due to secondary or derived 
currents. ' 

Organic substances, when submitted to the action of the galvanic 
current, undergo decomposition. The effects are proportionate to the 
number and size of the elements. Electrolysis is the term applied to 
the electric decompositions. The constituents of the tissues obey the 
ordinary laws of electrolysis — the acids and chlorine appear at the posi- 
tive pole, and the alkalies at the negative pole. The effects produced 
at the poles are due respectively to the acids and alkalies which appear 
at them, and the degree of action is determined by the amount of 
electricity which passes in a given time. The cauterizing action of 
the anode and cathode, or positive and negative poles, may be in- 
creased by introducing into the current a salt, such as the iodide of 
potassium, for example, the iodine appearing at the positive pole and 
the potassa at the negative. 

Faradism and galvanism differ in their action on the circulation. 
In order to understand this, it is necessary to note that when a spas- 
modic contraction of the vessels is produced, a diminution of the amount 
of blood in the part takes place ; on the other hand, when the organic 
muscular fibre acts, when stimulated, in the normal vermicular manner, 
the amount of blood is increased. An induction, or faradic current, 
causes a contraction of the arterioles by inducing spasm of the organic 
muscular fibre ; and a continuous galvanic current, by increasing the 
vermicular movements of the vessels, increases the flow of blood and 
elevates the temperature. An interrupted galvanic current has the 
same effect upon the vessels as the faradic. 

A current which passes from the spine to the periphery is said to 
be descending, or centrifugal ; from the periphery to the spine, as- 
cending, or centripetal. The direction of the current influences the 
results of electrical excitation. A descending current increases the 
amount of blood in the part by increasing the peristalsis of the arte- 
rioles; an inverse or ascending current has the opposite effect. A cen- 
trifugal current (descending) increases the afflux of blood to the uterine 
vessels, and favors the occurrence of the monthly flow. Also, a de- 
scending current which stimulates the organic muscular fibres of the 
arterioles, increases the amount of blood in the erectile tissues. 

The descending or centrifugal current acts most strongly on the 
motor nerves, and the ascending or centripetal current affects more the 
sensitive nerves. The excitability of the nerves is diminished by a 
direct or descending current, and increased by an inverse or ascending 



ELECTRICITY. 097 

current, whence it follows that a nerve fatigued by a descending current 
has its excitability restored by an ascending current, and a nerve whose 
excitability has been increased by an ascending current may be made 
to lose its excitability by a descending current. When motor nerves 
and muscles are brought within the circuit, the muscular contractions 
are strongest at the closing, whatever may be the direction of the cur- 
rent. An ascending current causes more energetic muscular contrac- 
tions when the sensibility of the part is preserved, but, when the sensi- 
bility is diminished or abolished, the contractions are feebler. The 
muscular contractions, under these circumstances, are much stronger 
when a descending current is used. The contractions produced by an 
ascending current are probably reflex, or induced contractions. 

The stronger the current, within certain limits, the more energetic 
the muscular contractions, and changes of intensity increase the effect 
according to their rapidity. 

Currents of induction (faradic) differ from galvanic currents in their 
effects on the muscles. When the interruptions are rapid the muscle is 
thrown into a tetanic state ; but, when slower, the contractions are mo- 
mentary and successive, with intervals of relaxation. The direction of 
the current appears to have no influence over the results. When a 
mixed nerve (motor and sensitive) is stimulated by an induced current, 
muscular movements take place and pain is experienced. The more 
rapid the interruptions, the more decided are the effects. If the electric 
stimulation of a nerve continues for a long time, it loses its excitability. 

The effects of electrical currents on the spinal cord may be summa- 
rized as follows : 

The descending current acts on the motor nerves, giving rise to vio- 
lent contractions of all the muscles of the body, and on the sensory 
nerves, causing pain. The ascending current increases the excitability 
of the cord and augments the reflex function ; while the descending 
current has the opposite effect. 

The question of the electric excitability of the cerebral hemispheres 
is yet sub judice. Hitzig, and Fritsch, and Ferrier, by a series of ex- 
periments, now well known, have apparently demonstrated the excita- 
bility of the hemispheres, in opposition to the doctrines long since laid 
down and universally accepted, of Magendie, Flourens, and others 
Hitzig and Ferrier have shown that certain parts of the brain respond 
in a very definite manner to electric stimulation, and in this way local- 
ization of the functions of the brain has been much advanced. In a se- 
ries of electrical experiments on the brain of a woman exposed by an 
epithelioma, I was enabled to demonstrate the homology of the func- 
tion of the brain of animals and man. 

Modes op applying Electricity. — Although it is a general prin- 
ciple that electricity should be applied to the seat of the morbid action, 
it is also true that much relief is often experienced from applications to 



•298 EXCITO-MOTORS. 

parts in which symptoms are felt. In cases of hemiplegia, for example, 
the best results are obtained by galvanization of the brain and fara- 
dization of the paralyzed muscles. Numerous illustrations of the same 
truth might be adduced. 

Electrical currents are applied to parts by means of electrodes^ con- 
nected by flexible wires with the poles — the anode and cathode — of the 
battery. Electrodes are of various forms and sizes, and are usually 
merely holders of sponge, or are pieces of steel, copper, or carbon, cov- 
ered with sponge, with ebony or hard-rubber handles. When the mus- 
cles and internal organs are to be reached by the current, the sponges 
are moistened with warm water or a solution of salt. As has already 
been stated, the conductivity of the tissues depends on the quantity of 
water contained in them ; hence, in order to overcome the resistance 
offered by the skin, the sponges should be well moistened. On the 
other hand, when it is desired to confine the electrical current to the 
skin itself, the skin should be rubbed dry and dusted with a drying- 
powder. The electrical brush, consisting of a bundle of fine wires, or 
of a number of flexible-wire electrodes, is often used when the current is 
to be confined to the skin. 

To galvanize the brain one pole may be placed on the forehead, the 
other on the occiput, or a pole may be placed on each mastoid process, 
or on each temple. Whatever may be the situation of the electrodes, 
flashes of light, a metallic taste, and vertigo, will be experienced if the 
current has sufficient force to traverse the brain. From three to ten 
cups will usually produce these symptoms ; hence, a larger number 
should not be used, and the applications should not continue longer 
than five minutes. 

Dr. Beard styles that method " central galvanization " in which one 
pole is placed over the occiput and the other over the epigastrium, the 
first pole being gradually moved down over the neck and spine so as to 
bring the cord and the great nerve-trunks of the body within the cir- 
cuit. The spinal cord is galvanized by placing one pole on the nape of 
the neck, and the other over the sacrum. Much has been said recently 
of galvanization of the sympathetic. The superior ganglion of the sym- 
pathetic ma} r be brought within the circuit by one pole placed in the 
auriculo-maxillary fossa, and the other on the spinous process of the 
seventh cervical vertebra. Obviously, the superior portion of the pneu- 
mogastric, the spinal accessor}', the cervical plexus, etc., are also in- 
cluded. One pole placed in the auriculo-maxillary fossa and the other 
on the manubrium of the sternum bring within the circuit the cervical 
sympathetic, the pneumogastric, the cervical plexus, etc. To stimulate 
the phrenic nerve, place the anode or positive pole on the outer margin 
of the sterno-cleido mastoid, near the omo-hyoid muscle, and the nega- 
tive on the epigastrium. In order to electrize the ear it must be filled 
with warm water, and an electrode, made for the purpose, must be intro- 



ELECTRICITY. 099 

duced connected with the positive pole, while the negative is applied to 
the mastoid process. For electrization of the eye a soft, sponge-covered 
electrode may be applied directly to the organ. The larynx, rectum, 
bladder, urethra, and uterus, may be readily reached by insulated 
sound-electrodes. 

Muscles may be most effectively electrized by placing one pole on 
the belly of the muscles, and bringing the other pole in relation to the 
nerve-trunk supplying them. In works on electro-therapeutics these 
points are mapped out. Single muscles may be electrized best by Du- 
chenne's pointed electrodes. 

Diagnosis by Electricity. — By means of an electric current we 
determine the electro-contractility of the muscles. In health the mus- 
cles respond to the galvanic current at the opening and closing of the 
current, and to the rapid interruptions of the faradic current. In cer- 
tain states of disease the "irritability" and the "contractility" of 
muscle may be increased, lessened, or destroyed. In paralysis of cere- 
bral origin the electro-contractility is not usually impaired, and may 
indeed be heightened. Also, in diseases of the spinal cord, the electro- 
contractility is impaired or destroyed only in those muscles the nerves 
innervating which come off from the injured portion of the cord, and is 
not affected in those muscles receiving their nervous supply from a 
healthy portion of the cord below the seat of disease or injury. The 
electro-contractility is lost in muscles when the motor nerves supplying 
them are cut off from their origin in the spinal cord. Hence it follows 
that if a paralyzed muscle responds to an electrical current the lesion 
is not in the nerve, or in that part of the spinal cord from which the 
nerve takes its origin. The contractility of muscles is increased when 
the brain or spinal cord is in a condition of increased irritability, as 
occurs, for example, from recent injury, acute congestion, etc. When 
the electro-contractility of muscle is diminished in cases of cerebral dis- 
ease, this effect is usually simply the result of disuse of the muscles, 
and is quickly restored by exercising them with a faradic current. Loss 
of electro-contractility may be due to some direct injury to the muscle, 
as from a blow, cold, or rheumatism — paralysis of the deltoid from a 
blow on the shoulder, of the muscles of the face from cold affecting the 
pes anserinus of the seventh, etc. Muscles thus affected, and incapable 
of responding to the faradic current, may react energetically to a slowly- 
interrupted galvanic current. 

The condition of muscle and nerve must be studied separately. In 
cases of paralysis due to disease of the muscles themselves, the changes 
in the electrical reaction of the muscles have been entitled by Erb 
" the reactions of degeneration." The normal reactions with which 
the diseased must be compared are as follows : the weakest current 
causing a muscular contraction is the cathodal closing, and no move- 
ment from the anode. "With a current of medium strength, the cath- 



300 EXCITO-MOTORS. 

ode causes stronger contractions and the anode feeble contractions, 
both on opening and closing the circuit. When the current is very- 
strong, there are decided opening and closing anodal contractions, and 
tetanic contractions on cathodal closing. When the anode is placed 
over the motor nerve, and the circuit is completed by putting the 
cathode on the muscle, it is entitled cathodal closing, and is expressed 
by the letters C C. The movement is entitled cathodal opening (C O) 
when the current is broken by removing the cathode ; anodal open- 
ing (A O) and anodal closing (A C) are opposite phases to the cath- 
odal. In disease, the first change noted is in cathodal closing, which 
disappears, and cannot be induced by an ordinary strength of current ; 
next, the anodal closing contraction ceases, and then the anodal open- 
ing contraction is no longer produced ; and, finally, the closing cathodal 
contraction can be induced only by the most powerful currents. No 
response to any strength of galvanic current signifies destruction of 
the muscular elements. When paralysis is due to disease of the motor 
nerves, it is important to distinguish between the nerve reactions and 
the muscular. When a motor nerve is inflamed from disease or injury, 
there is a brief period in which the irritability of the muscle is height- 
ened, and a less strength of current will cause contraction than is 
necessary in health, but after this a quantitative decline takes place in 
the nerves from the second or third day, and with both galvanic and 
faradic currents. If the injury is complete and irreparable, the quan- 
titative decline continues, and by the twelfth day, sometimes earlier, 
the electric excitability disappears entirely. If the nerve recovers, the 
muscles react to voluntary impulses before they do to galvanic or fara- 
dic stimulation of the nerve. It must not be forgotten that, while the 
motor nerves react in the mode above described, the muscles undergo 
the reactions of degeneration. When the spinal cord is the seat of 
disease inducing paralysis, the reactions are different from those just 
described. In the true spinal paralysis, that part of the cord is the 
seat of disease from which come off the nerves supplying the para- 
lyzed parts. In the myopathies of spinal origin (Charcot) we find 
typical examples of a spinal paralysis — notably, infantile paralysis. 
In a few days after the paralysis is manifest, a decline in the electric 
excitability of the motor nerves becomes manifest. It is a quantitative 
and not a qualitative change. It is found that not only are stronger 
currents required to produce contractions, but the : contractions are 
relatively feebler than in health. This decline in electric excita- 
bility continues, and by the end of the second week, sometimes by 
the end of the first, the galvanic and faradic excitability is entirely 
lost. 

The electrical reactions of the muscles in spinal paralyses, of the 
kind under consideration, are the reactions of degeneration. The 
muscles rapidly lose their excitability to the faradic current, and at 



ELECTRICITY. 301 

the expiration of two weeks it is extinguished. The conditions are 
different as respects the galvanic current. During the first week of 
the paralysis, the galvanic excitability declines with the faradic, but a 
remarkable change occurs in the second and succeeding weeks. The 
galvanic excitability then begins to increase, and goes on increasing 
for several weeks, while qualitative changes occur in the order and 
manner of contraction. So great is the increase in the galvanic exci- 
tability, that a strength of current insufficient to move the healthy 
muscles, will now cause strong contractions. The law of muscular 
contraction also changes. A gradual increase in the anodal closing 
contraction occurs, so that it soon equals, even surpasses, the cathodal 
closing, and, at the same time, the cathodal opening contraction de- 
clines in the same ratio (Erb). With the degeneration of the muscles 
there ensues a quantitative decline in the contractions, a very feeble 
anodal closing contraction being the last evidence of vitality. When 
improvement occurs, the galvanic excitability declines, and the faradic 
is restored again. 

When the disease is situated in a part of the cord entirely above 
the motor nerves innervating the paralyzed parts, the electric reactions 
may be normal, or the irritability may be even somewhat increased. 
When a part of the cord is diseased, and some motor nerves arise from 
normal and others from diseased parts of the cord, the reactions will 
be mixed — some will be in accordance with diseased, and others with 
normal reactions. 

The electrical current may be used to diagnosticate changes of sen- 
sibility, and hysterical and feigned diseases. 

Therapy. — Allbutt made a number of experimental observations 
at the West Riding Lunatic Asylum on the therapeutical effects of 
electricity (galvanism) in psychical disorders, and he sums up his re- 
sults as follows : Marked improvement in acute primary dementia; 
distinct improvement in mania, atonic melancholia, and perhaps recent 
secondary dementia; no change observed in chronic dementia and 
some cases of melancholia, and an unfavorable effect in hypochondri- 
acal melancholia, and perhaps brain-wasting. In the cases reported 
by Allbutt, the current was sent through the head and through the 
cervical sympathetics. Benedict (page 222) reports three cases of 
mental disorder improved by galvanism. 

I have observed excellent results in the mental and other symp- 
toms — confusion of mind, impaired memory, hypochondriasis, ver- 
tigo, etc. — which result from imperfect nutrition of the brain, caused 
by atheromatous degeneration of the cerebral vessels. My method 
of application has consisted in transverse transmission of the current 
through the brain, using a current of sufficient intensity merely to 
cause slight giddiness, a faint metallic taste, and barely perceptible 
flashes of light. 



302 EXCITO-MOTORS. 

Galvanization of the brain and of the cervical sympathetics is one 
of the measures to be resorted to in acute active or passive congestion 
of the brain. Wakefulness, when not reflex in origin, and when de- 
pendent simply on the state of the vascular supply, is often relieved 
by galvanization of the brain. Insomnia may be dependent on either 
active or passive congestion. In the first case a continuous current of 
moderate intensity should be passed through the superior ganglion of 
the sympathetic — the positive pole being placed in the auriculo-maxil- 
lary fossa, the negative on the seventh cervical vertebra ; in the second 
case a mild current should be transmitted transversely through the 
brain, and be slowly interrupted. 

To promote absorption of the clot in cases of cerebral haemorrhage, 
and to relieve the collateral cedema in embolism of the cerebral arte- 
ries, very mild galvanic currents may be employed. Caution is neces- 
sary, however, in employing galvanism in such cases. Strong currents 
and lengthened applications may do serious mischief ; but the author 
believes, with Remak, that judicious application of galvanism will be 
useful. The immediate effects of the embolism, or of the haemorrhage, 
should be allowed to subside before commencing the use of electricity, 
and, if there be much headache and vertigo, the greatest circumspec- 
tion will be necessary. 

In hemiplegia the constant current may be applied to the brain, for 
the purpose of improving its nutrition, and the faradic or induced cur- 
rent to the muscles, to prevent wasting and loss of function from dis- 
use. If the temperature of the paralyzed parts is lowered, the skin 
discolored and roughened, the muscles weak and flabby, much improve- 
ment in all these particulars will follow faradization. Large electrodes, 
well moistened, should be used, and all the muscles should in turn be 
made to contract — one pole being placed over the motor nerve, the 
other over the bellies of the affected muscles. In cases of hemiplegia, 
when the nutrition of the skin and muscles has been improved to the 
extent which faradization can accomplish, no advantage can accrue from 
further persistence in the applications. In faradizing the muscles in a 
case of hemiplegia, a current of just sufficient intensity to cause con- 
tractions should be used. Tetanic cramps fatigue the muscles, and are 
harmful. The so-called " late rigidity " — the muscular contractions 
which ensue after a time in hemiplegia, and which occur chiefly in the 
forearm and hands — is best treated by a continuous current to the con- 
tracted flexors, and an interrupted or faradic current to the relatively 
weaker extensors. 

In recent affections of the spinal cord, as a rule, electricity is not 
indicated. In chronic myelitis, syphilitic diseases of the meninges, 
after a course of suitable specific treatment, and in some of the sequela? 
of acute meningitis, much good may be accomplished by the galvaniza- 
tion of the spine and the paralyzed muscles. The wasting of the af- 



ELECTRICITY. 303 

fected muscles may be arrested and their nutrition raised to the normal, 
and the paralysis of the sphincters may, in many cases, be relieved. 
When the electro-contractility of the muscles is not impaired, and when 
they have not wasted, no good is to be accomplished by stimulating 
them with the electrical current. 

That very troublesome disorder, spinal irritation, with its extensive 
irradiations of nerve-pain, is much benefited by an inverse galvanic cur- 
rent, according to Hammond, and this observation I have been enabled 
to confirm by my own experience. Hysterical jxtndysisoi the extrem- 
ities, accompanied or not with anaesthesia or hyperesthesia, should be 
treated by galvanization of the spine and faradization of the muscles. 

In paralysis from lead (dropped wrist), the muscles may be so far 
atrophied as not to respond to faradization, but may react when stimu- 
lated by a slowly-interrupted galvanic current. When this condition 
exists, the interrupted galvanic current must be first employed, and the 
cure be completed by the faradic current when the muscles are so far 
improved as to react to the latter. 

The best example of a peripheral paralysis is that of the muscles 
of the face, from disease or injury of the facial nerve. From exposure 
to cold, or disease of the ear, or traumatic injury, the nerve is damaged, 
and the muscles to which it is distributed are paralyzed. In accordance 
with the law already given, such muscles do not respond to the faradic 
current, but do react to galvanism. The positive pole is placed over 
theses anserinus, or on the mastoid process, and the negative is made 
to pass over the peripheral expansion of the nerve so that all the mus- 
cles innervated by the nerve are brought into action. A curre*nt of 
sufficient intensity to induce muscular contraction must be employed. 
As in the case of other peripheral paralyses, after a time the affected 
muscles recover their power of response to faradism, when this form of 
current may be used to complete the cure. If the nerve has not been 
irrevocably damaged, and if the paralysis has not existed so long that 
the electro-contractility is lost in consequence of atrophic degeneration 
of the muscles, a cure of facial paralysis may be effected by a persistent 
use of electricity. 

Certain of the ocular paralyses, as of the third, fourth, and sixth 
nerve, are often cured by electricity (interrupted galvanic current). It 
is necessary, in order to obtain a successful result, that the remedy be 
employed in suitable cases. When these paralyses are dependent on 
cerebral tumors, syphilitic gummata, exostoses, etc., electricity cannot 
be expected to cure ; but the paretic state of the muscles, left after the 
removal of the gummata, may be promptly relieved by galvanization. 
The functional states of the above-mentioned nerves, of which paralysis 
may be a symptom, will certainly be cured by electricity. Faradism 
may sometimes succeed when galvanism fails in these cases (Althaus). 

Cases of aphonia, when dependent ou paralysis of the vocal cords, 



304 EXCITO r HOTORS. 

are sometimes cured by a single application, and few, indeed, resist the 
proper use of galvanism. The larynx may be faradized externally ; the 
recurrent laryngeal may be galvanized by placing one rheophore over 
its trunk and the other over the larynx, or, what is better, an intra- 
laryngeal electrode (Mackenzie's) may be used. 

Paralysis of the bladder and of the sphincter ani, even when symp- 
tomatic of spinal affections, may be greatly benefited, and the condition 
of the patient rendered much more comfortable, by an interrupted gal- 
vanic or faradic current applied by suitable insulated electrodes. Idio- 
pathic cases of these affections may be cured in this way. Constipa- 
tion, due to atony of the muscular layer of the large intestine, can be 
overcome by the same means. An insulated electrode is introduced 
into the rectum, and a large, sponge-covered rheophore, well moistened, 
is passed over the abdomen so as to bring every part of the large in- 
testine within the circuit. 

The failure of respiration in opium narcosis can be most success- 
fully obviated by faradization of the muscles of respiration. A strong 
faradic current is one of the most effective means of causing uterine 
contractions in cases of post-partum hemorrhage. 

In certain of the " myopathies of spinal origin" but not in all of 
them, electricity gives excellent results. The most decidedly curative 
results are obtained in infantile paralysis. The electrical treatment 
should be begun early, but after the subsidence of all inflammatory 
symptoms. Good results may be looked for if the electro-contractility 
of the muscles is not lost, and if important changes have not occurred 
in the joints. In many cases the affected muscles, although not atro- 
phied, do not respond to the faradic current, but will to the interrupted 
galvanic. The latter should therefore be used until the muscles are put 
into a condition to respond to the former. Besides galvanization and 
faradization of the paralyzed muscles, the electrical treatment should 
include galvanic spinal-nerve and plexus-nerve currents. Thus far but 
little benefit has accrued from the electrical treatment of progressive 
muscular atrophy. If the initial change in this malady were myopathic 
(as asserted by Friedreich), good results from localized faradization 
might be obtained. The author's experience as to the curability of this 
disease by electricity is quite in accord with Onimus and Legros, who 
declare that it is without avail in this disorder. Posterior spinal 
sclerosis is sometimes retarded in its course and progress by electricity, 
and galvanization of the spine lessens somewhat the severity of - the 
neuralgic pains which belong to this malady. 

Nothing is more certain in therapeutics than the relief to pain by 
galvanization of the affected nerve or nerves. In tic-douloureux decided 
relief to the pain is obtained by electrical applications to the fifth, and 
a permanent cure not unfrequently results in those cases belonging to 
the category of the essential neuralgise, so called. The best method of 



ELECTRICITY. 305 

application is that advised by Onimus and Legros, -which consists in 
placing the positive pole. on the point of emergence of the affected 
nerve, and the negative over the superior ganglion of the cervical sym- 
pathetic. About ten elements of Siemens and Ilalske is the proper 
strength, and live to eight minutes the proper time, for these applica- 
tions. This method of treatment is, according to Frommhold, the 
most effective remedy for migraine or kemierania. 

In cervico-brackial neuralgia, and in sciatica, excellent results are 
obtained by galvanization of the affected nerves. The positive pole 
should be placed over the point of emergence of the nerves from the 
cord, and the negative over the main divisions of the peripheral expan- 
sion. Both labile and stabile currents may be employed. A current 
from thirty elements will usually be required. The electrodes should 
be large sponges well moistened. In old cases of neuralgia, a needle 
such as is used for acupuncture, but insulated to near its point, may be 
introduced down to the neighborhood of the nerve-trunk and attached 
to the positive pole, while the negative sponge-electrode may be passed 
over the course of the nerve. This mode of galvanization is especially 
to be recommended in old cases of sciatica. A daily seance of from 
live to fifteen minutes is required usually in cases of neuralgia. The 
cure is much more difficult, and the applications must be continued 
over a much longer period of time, in those cases of neuralgia depend- 
ent on neuritis. Decided amelioration and even cure may be hoped 
for by sufficiently prolonged applications, when the nerves are so far 
altered that induced currents do not cause any muscular contractions. 
Some of the most satisfactory results have been obtained from galvan- 
ization of the uterus in uterine and ovarian nerve-pain. 

In certain kinds of muscular spasm the galvanic current has un- 
questioned utility. Cases of spasmodic wry-neck (torticollis) of recent 
origin, due to "rheumatism," are quickly relieved by galvanization by 
stabile currents of the affected muscles, and faradization of the opposed 
muscles. Old cases of wry-neck and convulsive tic of the face, and 
writer's cramp, are not benefited by this treatment. Cases of chorea 
have been cured by static electricity, but little benefit has been derived, 
according to the author's observation, from galvanism or faradism. 

Galvanism is sometimes of great service in epilepsy, but no exact 
indications for its use can be laid down. Obviously it can only be ser- 
viceable in idiopathic epilepsy. The applications should include the 
brain (transverse current from mastoid process), the cervical sympa- 
thetic, and those nerve-trunks along which an aura is transmitted. 

The author has witnessed some remarkable results from the galvan- 
ization of the pneumogastric nerves, and as conspicuous failures from 
the same practice, in spasmodic asthma. Even in those cases not per- 
manently improved, great relief to the difficult breathing is experienced 
when the current is passing. The positive pole is placed over thepneu- 
21 



306 EXCITO-MOTORS. 

mogastric, beneath the mastoid process, and the negative pole is applied 
to the epigastrium. Faradism is not serviceable in this disease. 

Exophthalmic goitre, a disease of the sympathetic system and 
manifested objectively by proptosis, goitre, and palpitation of the heart, 
is cured by galvanization of the cervical sympathetic and of the pneu- 
mogastric, and by applications to the eyes and thyroid gland. 

There can be no reasonable doubt of the influence of electricity over 
the nutritive functions. Beard and Rockwell employ the method termed 
by them " general electrization," which consists in faradic applications 
to the surface of the body, " one pole, usually the negative, being placed 
at the feet or the coccyx, while the other is applied all over the surface 
of tbe body." They formulate their principles in these applications as . 
follows : " Constitutional diseases are better treated by general, and 
local diseases by localized electrization." According to Benedikt — and 
in this view electricians are generally in accord — the true method of 
using electricity consists in making applications to the affected part or 
organs, and, to this rule may be added, to those parts or organs also in 
which symptoms are felt. 

General electrization is useful " in those diseases that are dependent 
on, or associated with, impairment of nutrition and general debility of 
the vital functions, such as nervous dyspepsia, neurasthenia, ancemia, 
chlorosis, hysteria, hypochondriasis, paralysis, and neuralgia of a con- 
stitutional origin, rheumatism and other toxic diseases, some forms of 
chorea, and oftentimes in functional disorders of the genital, digestive, 
and other special organs." 

In ancemia and chlorosis the usual remedies for these states may be 
much assisted by central galvanization, and localized applications to 
the vegetative organs. Regurgitation of food, gastralgia, and feeble- 
ness of digestion, are often signally benefited by galvanization of the 
pneumogastrics, and by localized applications to the abdominal organs. 
Strong currents are needed when internal organs are to be affected by 
electrodes applied to the integument of the abdomen. A more effec- 
tive application in these cases consists in the use of an insulated rectal 
electrode, while a sponge electrode of large size, and well moistened, is 
passed over the various organs of the abdomen. The relief of consti- 
pation by this means has already been alluded to. 

Various diseases of the pelvic organs, both in the male and female, 
are successfully treated by electricity. Amenorrhoea, when dependent 
on atony of the ovaries and uterus, is cured by static electricity, by 
faradism, or by an interrupted galvanic current. A shock from a 
Leyden-jar may be transmitted through the pelvis, or a strong faradic 
or galvanic current may be applied by means of one pole on the spine, 
the other on the hypogastric region. In the case of married women an 
insulated vaginal electrode may be introduced and placed in contact 
with the os uteri. This is a more effective way of making the applica- 



ELECTRICITY. 307 

tions than by the electrodes placed externally. In rn uralgic rfysmenor- 
rhcea the galvanic current will afford relief in a large proportion of 
ca^es; and, in congestivt dysmenorrhcea, an inverse current will di- 
minish the blood-supply, and thus lessen suffering. The treatment of 
these affections should be conducted during the interval. The chronic 
congestive enlargement of the uterus is sometimes remarkably benefited 
by a galvanic current of moderate intensity slowly interrupted, but it 
is doubtful if any case of chronic interstitial metritis is ever cured, or 
even ameliorated, by this means. 

Although the changes in the joints, induced by gout and rheumatism, 
may not be cured by galvanization of the central nervous system, as 
claimed by Meyer, yet there is no doubt that myalgia, lumbago, and 
other so-called rheumatic diseases of the muscular system, may be 
promptly relieved and cured by the constant current. The stiffness of 
the joints and the muscular soreness which remain after an attack of 
acute rheumatism are best relieved by passing a mild galvanic current 
through the affected parts. 

Herpes, especially herpes zoster, and prurigo, when they are refer- 
able to an alteration of the cutaneous nerves, are curable by electricity. 
The author has seen excellent results in cases of shingles, from gal- 
vanization of the affected intercostal nerves — the positive pole being 
placed over the point of emergence of the nerves, and the negative- 
brushed over the terminal filaments in the skin. Beard reports the cure 
of obstinate cases of chronic eczema by central galvanization, and his 
results have been confirmed by others. The author has seen a number 
of cases of acne get well under the influence of galvanization of the 
cervical sympathetic, and local galvanization of the skin of the face — 
the positive pole on the neck, the negative passed over the affected 
parts. It need hardly be stated that strong currents are not to be 
used when the poles are applied in these situations. Among the other 
skin-affections treated by galvanism with success are prurigo, psoriasis, 
and even scleroderma ; but, as Dr. Piffard, of New York, has remarked, 
this method is "by no means uniformly successful." It is applicable 
to the treatment of the neuroses of the skin. 

Electrolysis. — When the electrical current is made to traverse 
insulated needles introduced into the tissues of the body, electrolytic 
effects ai*e produced, decomposition of the tissues ensues, hydrogen and 
the alkalies appear at the negative pole, and acids and chlorine at the 
positive. Remak, in his various publications, much insisted on the 
catalytic action of the constant current. Effusions into and about in- 
flamed parts, and into the substance of tumors, may be made to dis- 
appear by the external application of galvanism, through moistened 
sponge electrodes. It is doubtful, however, whether neoplastic forma- 
tions can be thus made to iindergo absorption. The disappeai-ance of 
effusions induces such an appearance of shrinking of tumors and in- 



308 EXCITO-MOTORS. 

flammatory products, that actual absorption of the neoplastic material 
may be supposed to have occurred. 

Galvano-puncture is used to remove malignant and other new for- 
mations. The sanguine expectations once entertained that cancer can 
be thus removed, although justified by the results in a few apparently 
successful cases, have not been realized. Beard proposes and has exe- 
cuted a new method, "working up the base," which consists in electro- 
lytic decomposition of the subjacent parts of a cancel-. A number of 
needles, insulated to near their points, are introduced into the healthy 
tissues beneath the morbid growth, and a current from twenty to 
sixty elements is passed through them. Decomposition ensues, and 
there takes place a separation of the morbid mass. As the pain of this 
method is great, etherization should be resorted to. 

Aneurisms, so situated as to be beyond the reach of surgical inter- 
ference, have been treated by galvano-puncture, but the success, al- 
though brilliant in a few instances, has not been such as to justify 
very sanguine expectations of its future utility. Erectile tumors are 
curable by electrolysis. Goitre is sometimes made to disappear by 
the same means. The cysts connected with glandular tumors in the 
neck may be permanently occluded by galvano-puncture. The most 
useful applications of this method have been in hydrocele, which may 
be often cured in my experience by introducing two needle-elec- 
trodes, insulated to near their points, and passing a current from 
twenty to forty elements. Not less effective is the same method in 
the treatment of hydatid disease of the liver. One needle connected 
with the negative pole is introduced, and the. sponge-electrode is 
placed at some indifferent point on the abdomen. 

Spasmodic and permanent stricture of the urethra are treated by 
electrolysis, an insulated sound with a metallic tip, connected with the 
negative pole, being passed into the stricture, and the positive pole 
placed at some indifferent point. The most successful results have 
been obtained by Mallez and Tripier, and Dr. Robert Newman, of 
New York ; but it is the author's observation, as also the experience of 
Dr. Keyes, of New York, that this method has little real utility. 

Wounds and idcers of an indolent character, and bed-sores, may be 
made to heal by attaching to them a galvanic couplet (zinc and silver), 
one of the elements remaining in contact with the sore, and the other 
on the skin in the neighborhood. They should be connected by a 
copper wire, and be confined to the parts by strips of adhesive plaster. 
This method has been especially serviceable in the treatment of bed- 
sores. 

Galvano-Cautery. — This method consists in cauterization by a 
platinum wire heated by the galvanic current. The battery used for 
this purpose furnishes a large quantity of electricity of low tension, 
hence the elements are few in number but having large surface. When 



ELECTRICITY. ;;il<) 

a large quantity of electricity is made to traverse a platinum wire which 
offers great resistance, the wire is heated and may he melted. The 
platinum in the form of wiredoop, or dome cautery, or knife, heated 
by the electrical current, is the cauterizing agent. If the wire he not 
so highly heated as to cut through the tissues too rapidly, but little 
bleeding results, and a clean surfaee is left which promptly granu- 
lates. 

It would be foreign to the scope of this work to enter into details 
in regard to galvano-cautery, which is a department of surgical prac- 
tice. It will suffice to mention briefly the principal applications of the 
method. It may be used to remove polypi, and other pediculated 
growths, to amputate tin: penis and cervix uteri, to separate hcemor- 
rhoids, noevi, lupus, and carcinoma, or to arrest bleeding in deep cavi- 
ties, or to cauterize sinuses. 

Static Electricity. — The modified Holtz or Toepler-Holtz elec- 
trical machine is now used to procure all of the nerve and muscular 
effects hitherto obtained by faradic electricity, and also therapeutical 
results of a very striking kind. It has long been known that chorea 
and other nervous affections maybe readily cured by static electricity, 
but a remarkable extension has been given to the subject by late dis- 
coveries. Chorea is now treated by the " electric bath," sparks being 
drawn from the spine. If the Holtz machine is used, sparks can 
readily be drawn through the clothing, by presenting the brass knob 
along the spine. The results, which have been so long obtained at 
Guy's Hospital by this mode of electrical applications, are now gener- 
ally obtained. It seems to be the most successful method of treating 
this disease. Xcuralgia is now promptly relieved in most instances by 
insulating the patient and drawing sparks from along the trajectory 
of the nerve affected. The pains of progressive locomotor ataxia are 
much benefited in the same way, and it is said the disease itself is 
arrested. Amenorrhoza, other conditions favorable, is quickly cured 
by sparks, or a shock sent through the pelvis. The general nutrition 
is greatly promoted by electrization by sparks. 

The Toepler-Holtz machine may, by connecting the interior of one 
condenser with the exterior of the other, be utilized to procure the 
muscle and nerve reactions of the faradic current. 

Trouve's Polyscope is an instrument for galvano-causty and elec- 
tric illumination. In this apparatus Plante's cell with its polarization 
current is utilized to furnish the current. Suitable throat and other 
mirrors, platinum knives, and loops, are furnished with the instrument 
for illumination of the cavities, and for the various caustic operations. 
It is very powerful, occupies but little space, and promises, when cer- 
tain mechanical defects are overcome, to fulfill more perfectly than 
any other apparatus the requirements of a surgical galvano-caustic 
and a medical illuminating apparatus. 



310 EXCITO-MOTORS. 

Authoi'ities referred to in this article : 

Allbutt, Dr. T. Clifford. The Electric Treatment of the Insane. TJie West Riding 
Lunatic Asylum Reports, vol. ii., p. 203. 

Althaus, Dr. Julius. A Treatise on Medical Electricity, second edition, Philadel- 
phia, 1870. 

Bartholow, Dr. Roberts Medical Electricity. A Practical Treatise on the Applica- 
tions of Electricity, etc., Philadelphia, H. C. Lea's Son & Company, 1881, pp. 262. 

Beard and Rockwell. A Practical Treatise on the Medical and Surgical Uses of 
Electricity, New York, 1871. 

Benedikt, Dr. Moritz. Elcktrotherapic, Wicn, 1868. 

Duchenne, Dr. G. B. (of Boulogne). Be P 'Electrisation Localisee, Paris, 1861. 

Eulenburg, Dr. Albert. Lehrhuch der functionellen Nervenkrankheiten, Berlin, 1871, 
p. 78, et seq. 

Frommhold, Dr. Carl. Die Migraine und ihr Heilung durch Eleclricilat, Pesth, 1868. 

Hammond, Dr. William A. A Treatise on Diseases of the Nervous System, New York, 
1871. 

Hamilton, Dr. Allan McLane. Clinical Electro-Therapeutics, New York, 1873. 

Jaccoud, Dr. S. Traite de Pathohgie Interne, vol. i., Paris, 1870. 

Morgan, Dr. Charles E. Electro-Physiology and Therapeutics, New York, 1868. 

Onimus, E., et Ch. Legros. Traite d ] 'Eleclricite Medicale, Paris, 1872. 

Remak, Dr. Robert. Galvanolherapie, traduit dc l'Allemand, Paris, 1860. 

Reynolds, Dr. J. Russell. Lectures on the Clinical Uses of Electricity, Philadelphia, 
1872. 

Voltolini, Dr. Rudolph. Die Anwendung der Galvano-Kaustic, Wien, 1872. 

Ziemssen, Dr. Hugo von. Die Eleclricilat in der Mcdicin, erste Halfte, Berlin, 1S72. 

Nux-Vomica. — The seeds of strychnos nux-vomica. JVoix vomiquc, 
Fr. ; Krahenaugen, Ger. 

Extractum Nucis Vomicae. — Extract of nux-vomica. Dose, gr. \ — 

Tinctura ISFucis Vomicce. — Tincture of nux-vomica. Dose, m. j — 
m. xv. 

Composition. — Nux-vomica contains two alkaloids and a peculiar 
acid. The alkaloids are strychnia and brucia, and the acid strychnic 
or igasuric acid. The proportion of strychnia ranges from one-fourth 
to one-half of one per cent., and of brucia from one-eighth to one per 
cent. These wide differences are in great part due to the varying skill 
of the chemists who have made analyses. Besides these another crys- 
tallizable base has been discovered in the mother-liquor from which 
strychnia and brucia have been precipitated. This has been named 
igasurine. The alkaloids exist in nux-vomica in combination with 
igasuric acid. 

Strychnia "is a white or grayish-white powder, of an intensely 
bitter taste, nearly insoluble in water, slightly soluble in cold alcohol, 
and readily soluble in boiling alcohol. When heated it melts, and by 
strong heat is wholly dissipated. It is but slightly or not at all red- 
dened by nitric acid. A small portion dissolved in official sulphuric 
acid yields, on the addition of a minute quantity of bichromate of 
potassium, a splendid violet-color." 



NUX-VOMICA. 311 

Strychnia} Sulphas. — Sulphate of strychnia. "A white salt, in 
colorless, prismatic crystals, which are without odor, exceedingly bit- 
ter, readily soluble in water, sparingly soluble in alcohol, and insoluble 
in ether. They effloresce on exposure to the air, and melt when heated, 
losing nearly fourteen per cent, of their weight of water of crystalliza- 
tion. By a strong heat they are wholly volatilized." Dose, gr. -fa — 

g r - ttV- 

Antagonists and Ixcompatibles.— The paralyzers, such as woorara, 
conium, tobacco, opium, belladonna, and physostigma, antagonize the 
actions of strychnia in a part of the sphere of its influence. They do 
not antagonize its toxic action. Chloral, tobacco, bromide of potassium, 
ether, and chloroform (inhaled), are its true physiological antagonists. 

In cases of poisoning, tannin and the vegetables containing it should 
be freely administered, for the tannate of strychnia is very insoluble. 
Emetics, or the stomach-pump, must be used promptly. The tetanic 
spasms are best controlled by chloral and the inhalation of ether, or by 
tobacco, or by the bromide of potassium in very large doses ( 3 ij — § ss). 
The maintenance of artificial respiration has a decided effect in post- 
poning in animals as in man the lethal action of strychnia. 

Synergists. — Brucia, picrotoxine, thebaine, ergot, and, according to 
my own experimental investigations, belladonna, electricity, cold, etc., 
promote the activity of nux-vomica and its alkaloids. 

Physiological Effects. — The preparations of nux-vomica are ex- 
tremely and persistently bitter. Like all bitters, they promote the flow 
of the stomach and intestinal juices, increase the digestive power, and 
thus favorably affect the appetite. They also hasten the intestinal 
movements, and the stools voided are somewhat relaxed. 

The alkaloids of nux-vomica are very diffusible substances, and enter 
the blood very quickly. They lessen somewhat the oxidizing power 
of the blood, but this effect is quite insufficient to account for the phys- 
iological reactions produced in the nervous system. Small medicinal 
doses of nux-vomica and its alkaloid accomplish no more than other 
bitters, as respects the circulation. More or less plethora, slightly in- 
creased action of the heart, and, as a consequence of this condition of 
the vascular system, a greater energy in the performance of the various 
functions, result from their administration. 

When a lethal dose of nux-vomica, or of its alkaloids, has been taken, 
characteristic symptoms follow in a few minutes. The state of the 
stomach as to food, the presence of tannic acid in the food, and of fat, 
probably, also the condition of the blood-vessels, influence the rate of 
absorption, and symptoms may begin in a few minutes or be delayed 
an hour or even longer. When a full medicinal dose has been taken, 
some slight shuddering, a sense of constriction of the fauces and jaws, 
sudden pains like electric shocks passing through the limbs, startings 
of some of the voluntary muscles, dilated pupils, " a meaningless smile," 



312 EXGITO-MOTORS. 

paleness of the face, followed by flushing and increased warmth of the 
surface and perspiration, are symptoms which may be produced without 
further development of a toxic action. If the dose be large enough to 
cause death, the above-described symptoms are quickly followed by 
tetanic convulsions, in which nearly all the voluntary muscles are en- 
gaged. "When the paroxysm occurs, a shudder passes through the whole 
frame; the head and extremities jerk and twitch, and then, suddenly, a 
general tonic convulsion takes place — the limbs are extended, the hands 
clinched, the toes and feet incurvated, the head bent backward, the 
body arched and rigid, the abdominal muscles hard and tense, the re- 
spiratory muscles fixed so that the body, curved in the form of a bow, 
rests on the occiput and heels. The countenance assumes a ghastly 
grin — the risus sardonicus / the arrest of the respiratory movements 
suspends oxidation of the blood, and the skin becomes cyanosed; strong 
erections of the penis occur, and frequently involuntary evacuations of 
semen, urine, and faeces take place. Rarely does death ensue in the 
first paroxysm ; the spasm relaxes, and nothing remains of the attack 
but the muscular soreness and fatigue, and the sense of impending dis- 
solution. Absolute quiet retards the paroxysms. At first the senses 
are preternaturally acute, and, as the reflex function is abnormally ex- 
citable, the slightest peripheral irritation suffices to bring on the spasms. 
Generally patients experience comfort when the limbs are strongly held, 
or even rubbed, during the paroxysms ; but, in the interval, absolute 
quiet is most grateful. The mind remains unaffected until the close, or, 
at least, until carbonic-acid poisoning sets in. The paroxysms rapidly 
succeed each other, and increase in duration and severity, death occur- 
ring usually by fixation of the muscles of respiration, or by exhaustion, 
and within two hours usually from the beginning of symptoms. 

The remarkable similarity in the symptomatology of traumatic 
tetanus and strychnia tetanus requires that the points of difference 
between them be clearly set forth. In strychnia tetanus the jaw-mus- 
cles are not first thrown into spasm, and are not always rigid during 
the paroxysm ; in traumatic tetanus, trismus is one of the first symp- 
toms. In strychnia tetanus, after the convulsion lasting from a half to 
one or two minutes, there is usually complete relaxation ; in traumatic 
tetanus rigidity of the affected muscles continues. A case of strychnia 
tetanus goes on rapidly increasing in severity, and lasts from a few 
minutes to two hours; a case of traumatic tetanus proceeds more slowly, 
and lasts always a number of hours, and may extend over days and even 
weeks. And, lastly, in traumatic tetanus, the capital symptom of a 
wound or injury exists. 

No very characteristic post-mortem appearances result from strych- 
nia-poisoning. The muscles, at first relaxed, become rigid, the feet 
turned in, the fingers clinched, or the body may maintain the position 
of opisthotonos, it which it was at the moment of death. Congestion 



NUX-VOMICA. 313 

of the cerebral and spinal meninges is usually observed, and Schrocdcr 
Van der ELolk has ascertained that dilatation of the vessels and san- 
guineous extravasations are found in the gray matter of the cord 
(medulla oblongata). 

The smallest quantity of strychnia which has produced a fatal result 
in an adult was a half-grain. Rarely can one-twelfth of a grain be 
given without causing muscular twitchings, and one-sixteenth of a 
grain has caused death in a child of between two and three years. 

The effects of strychnia are exerted on the spinal cord, on the seat 
of the motor functions. It does not affect the functions of the motor 
nerves directly — the irritability of the motor nerves is not destroyed 
by strychnia, it is exhausted by over-stimulation. The sensory nerves 
are either unaffected, or their irritability is exhausted. The reflex 
functions of the spinal cord are exalted. The afferent nerves, when 
preserving their irritability, communicate impressions to the reflex cen- 
tres, motor impulses are quickly originated, and the muscles through 
the motor nerves are fixed in a state of tonic contraction. The over- 
stimulation of the cord and the motor nerves exhausts the irritability 
of the latter. The muscles preserve their contractility. 

The effects of strychnia are not limited to the nervous system of 
animal life : the organic nervous system participates in the perturba- 
tion. The dilatation of the pupil, the erection of the hair-follicles, the 
tinnitus, the increased heat in the limb, and the perspirations which 
are produced when strychnia is injected subcutaneously, indicate an 
influence on the sympathetic system similar in kind to that exerted 
on the voluntary. Experimental investigations have confirmed these 
clinical observations. A very considerable rise in the arterial pressure, 
contraction of the vessels in the frog's web, and increased action of the 
heart, have been experimentally demonstrated to be caused by strych- 
nia (Sigmund Mayer). 

Magendie, who made the first study of the actions of strychnia, 
found that, by previously destroying the spinal cord, no convulsions 
followed the administration of a poisonous dose. The precise agency 
of the cord is disputed, but it is in a high degree probable that the 
condition is one of exaggerated reflex excitability, so that the smallest 
possible peripheric irritation induces a response in the reflex motor 
centre. When Setschenow's inhibiting centre of reflex movements is 
withdrawn as in the decapitated frog, the spasms are induced as before. 
The passage over the face of the faintest current of air, even the men- 
tal conception of such an impression, w r ill excite the spasms. Abso- 
lute repose, as by placing the poisoned frog under a bell-glass, the 
table firm so that no jar can reach the animal, and light excluded, has 
a decided effect in preventing attacks. If a poisoned human subject 
is similarly protected, the convulsions are diminished in violence. 
Again, if, when the convulsions are impending, the limbs are firmly 



314 EXCIT0-5I0T0RS. 

grasped and held, the force of the spasm is lessened thereby. The 
medicines most effective in affording relief are those which lower the 
activity of the reflex function — notably chloral, bromide of potassium, 
etc. These facts indicate that an exaltation of the reflex function of 
the spinal cord is caused by strychnia. But this is probably not alone 
sufficient : irritation of the motor cells is also a factor (Spitzka). In 
opposition to the commonly accepted view, Falck maintains that 
strychnia acts primarily on the brain, or rather on the vaso-motor cen- 
tre of the brain, then on the inhibitory centre for the heart, and the 
respiratory centre, and lastly on the reflex apparatus of the cord. The 
spasms are the combined results of these actions. 

Bernard held that the sensibility of the sensory nerves is destroyed 
by strychnia, but after the motor functions have ceased. Martin- 
Magron, and subsequently Vulpian, ascertained that the sensibility 
persists after motility has ceased. This contradiction of supposed 
facts has been examined more recently by Busch, whose observations, 
if entitled to belief, support the statement of Bernard. Busch has 
found that the toe of the poisoned frog may be crushed, and the cen- 
tral portion of the divided sciatic maybe burned, without inducing 
spasms or reflex movements, when the slightest jar of the animal will 
cause strong convulsions. Kolliker and Vulpian, with many others, 
hold that the excitability of the motor nerves is so far impaired by 
strychnia, that irritation of the nerve-trunk produces very feeble or no 
muscular contractions. The American observers Klapp and Spitzka 
both maintain that the peripheral nerves are unaffected in strychnia- 
poisoning. Martin-Magron et Buisson and Vulpian find that the action 
of strychnia is local on the nerves, and is therefore greatly influenced 
by the quantity of the poison reaching them. If the dose of strychnia 
is small, therefore, the motor and sensory nerves remain unimpaired ; 
but if the dose be large, it is destroyed. The influence of the quan- 
tity administered is very great, therefore, and is exhibited in other re- 
spects. Thus, while a merely lethal dose causes strong convulsions, a 
very large toxic dose will kill at once without any reflex disturbances. 
It is impossible, then, to make the distinction between motor and sen- 
sory nerves as respects the action of strychnia : it either destroys or 
spares the excitability of both. 

While strychnia exalts the irritability of the reflex motor centre, 
it stimulates the vaso-motor centre or centres in the cord, with the re- 
sult of greatly increasing the blood-pressure. This rise in blood-press- 
ure is prevented by dividing the cord, according to Mayer, Klapp, and 
others, but, according to Schlesinger, not. Now, as it has been found 
by Richter, who has studied the circulation in transparent parts, by 
Mayer, and by Spitzka, that the arterioles strongly contract under the 
influence of strychnia, the blood-pressure must rise from this cause ; 
hence, the observation of Schlesinger is probably correct, that the 



* NUX-VOMICA. 315 

blood-pressure rises in strychnia-poisoning, notwithstanding division 
of the cord. As has been tersely expressed by Spitzka, " its vaso- 
motor effect is to increase the blood-pressure and the rapidity of the 
blood-current by contracting the arterioles. This effect is independent 
of the central nervous system." The effects of strychnia on the heart 
differs in cold- and warm-blooded animals, according to most authori- 
ties, and decidedly, also, according to the size of the dose. On frogs, 
the diastolic pause is prolonged, and the force of the systole aug- 
mented, so that arrest of the heart's action may take place in tetanic 
rigidity. These results, Spitzka holds, are due to an action on the 
cardiac ganglia and on the pneumogastric. The previous observations 
of Heinemann, however, do not correspond, for he finds that these phe- 
nomena are produced after the vagi are divided. In warm-blooded 
animals the heart's action is accelerated, while the tension is raised. 
Klapp, however, finds that strychnia slows the pulse in the cat and 
rabbit, and that the retardation is due to an impression on the cardiac 
motor ganglia, and not to stimulation of the inhibition. He finds that 
the action is the same on both classes of animals. These contradic- 
tions are probably due to the difference in the dose employed. A large 
toxic dose of strychnia will paralyze, instead of stimulate, the vaso- 
motor centre in the medulla, and thus prevent any rise of blood press- 
ure. A small, merely lethal dose will stimulate the cardiac ganglia, 
the pneumogastric, and the vaso-motor ganglia; but a large toxic dose 
will slow the heart, paralyze the vagi and the accelerator apparatus, 
and depress the vaso-motor functions generally. In the course of an- 
nual experiments for class-instruction, the author has constantly ob- 
served the difference in results due to the quantity administered. 

From clinical observation, in the absence of any experimental evi- 
dence, strychnia has been ascertained to have a stimulating effect on 
the respiration. If the dose is less than sufficient to tetanize, the func- 
tion of respiration is increased in energy and in depth. Hence, this 
agent antagonizes the respiratory poisons, as well as those morbid 
states which depress the respiratory function. 

On the blood, the experiments of Harley show, strychnia has some 
action. Agitation of blood with the air, in the presence of strychnia, 
is followed by a less production of carbonic acid than if strychnia be 
not present, but such experiments are entitled to small consideration. 
Strychnia, as Hippel and Cohn have shown, stimulates the retina 
and increases the sharpness of definition and the area of the visual 
field. These facts explain the curative effects of strychnia in certain 
diseases of the retina. 

Very peculiar phenomena have been observed by Spitzka as a re- 
sult of chronic poisoning — an entirely new subject. It appears to be 
exceedingly difficult to keep animals alive, but Spitzka succeeded in 
maintaining five frogs in tetanus for over forty days. Symptoms 



316 EXCITO-MOTORS. 

occur under these circumstances quite distinct from those produced in 
acute poisoning by strychnia. Disease in the cord is set up " partly as 
an insular sclerosis, partly as an hsemorrhagic or non-haemorrhagic 
myelitis." These exjjeriments demonstrate that, to maintain a con- 
stant effect by strychnia in the beginning, the dose must be increased, 
but later the quantity given may be decreased and administered at 
longer intervals. The importance of these observations from the 
therapeutical point of view is, indeed, great. The symptoms occur- 
ring from chronic poisoning are, as respects the' spasms, a diminution 
of their energy, the development of an ataxic state, with tremors and 
pupillary myosis. These phenomena approach those produced by pi- 
crotoxine, and are intermediate between the effects of strychnia p roper 
and of curara or methyl strychnium. 

Therapy. — The tincture of nux-vomica is one of the numerous 
remedies proposed for the vomiting of pregnancy. It is best adapted, 
according to the author's observation, to those women who have a sea- 
sick feeling and who do not vomit much. Half a drop to a drop, in 
cherry-laurel water, or in simple water, every hour or two, is a suitable 
dose. Like all other remedies, nux-vomica often fails in this malady, 
Owing partly to its intense bitterness, and partly to its influence on 
the nervous system, the tincture of nux-vomica is an excellent stomachic 
tonic, adapted more especially to the treatment of those cases in which 
there is a neurotic element, as, for example, atonic dyspepsia and gas- 
tralgia. From five to ten drops three times a day before meals is a 
suitable dose in these cases. In chronic gastric catarrh, whether 
occurring as an independent affection, or as an accompaniment of other 
maladies, the tincture of nux-vomica is one of the most effective bitters. 
In the gastric catarrh and morning vomiting of drunkards, this 
remedy is next in value to arsenic. It may be given, advantageously, 
with mineral acids. The poor appetite, the feeble digestion, and the 
nervous7iess and trembling, which follow the sudden withdrawal ot 
alcoholic stimulants, may be removed by frequent small doses of the 
tincture. To diminish the craving for stimulants when they are with- 
drawn, and to sustain the nervous system, the following combination is 
exceedingly effective : I}, . Tinct. capsici, 3 vj ; tinct. nucis vom., 3 ij. M. 
Sig. Twenty drops in water every four hours. Intestinal indigestion 
and flatulence are also removed by tincture of nux-vomica. 

In atonic diarrhoea, nux-vomica is a serviceable addition to other 
remedies, when a paretic condition of the muscular layer of the bowel 
may be presumed to exist. It is, however, more especially in constipa- 
tion that nux-vomica is useful. It is indicated in those cases in which 
there are inaction of the muscular layer and, consequently, great fecal 
accumulations. It may be most advantageously given with purgatives 
in such cases: 1$. Tinct. aloes et myrrhse, 3 vj ; tinct. nucis vomicae, 
3 ij. M. Sig. Fifteen to thirty drops two or three times a day. 



NUX-VOMICA. 317 

Nux-vomica has been signally useful in some forms of epidemic 
dysentery. It is indicated when there is depression of the vital forces, 
the intestines distended with gas, the stools like prune-juice. In some 
epidemics of cholera, strychnia, combined with mineral acids and 
opium, has appeared to be effective when the patient was about to pass 
into the state of collapse ; and it has also been used as a prophylactic 
during the preliminary diarrhoea: 1$. Strychnia) sulphat., gr. \ ; acid, 
sulphuric, dil., §ss; morphias sulphat., gr. ij ; aquse camphors, 3 iijss. 
M. Sig. A teaspoonful every hour or two, well diluted. This combi- 
nation is also effective in summer diarrhoea, when the evacuations are 
very watery, and in colliquative diarrhoea. When there is much pain, 
the quantity of morphia may be increased, or the first dose may be 
doubled. When the character of the case is such as to require con- 
tinued use of the prescription, of course, the quantum of strychnia must 
be lessened. 

Nux-vomica and its alkaloid strychnia are much used in combina- 
tion with restorative remedies, in cases of impoverished blood — in 
ana>mia, chlorosis, hmmorrhagic diathesis, purpura, etc. In anaemia 
and chlorosis strychnia is used with reference to its power to stimulate 
the blood-making organs, which functionate under some special influ- 
ence proceeding from the nervous system. IJ. Ferri sulph. exsic, 3ij; 
quiniae sulph., 3 j ; strychnioe sulph., gr. ss. M. ft. pil. no. xx. Sig. 
One pill three times a day. No prescription is more generally useful 
in these states than the sirup or elixir of iron, quinia, and strychnia, a 
formula originally proposed by Aitken. 

In the treatment of amenorrhcea, the preparations of nux-vomica 
and strychuia frequently enter into the composition of prescriptions. In 
postpartum haemorrhage, Fordyce Barker prescribes the tincture of 
nux-vomica (twenty drops), and fluid-extract of ergot (thirty drops), 
" every half-hour until well assured that the uterus is well contracted." 
It is obvious that not more " than two or three doses " of such strength 
will be safe. The neuralgic form of dysmenorrhoza may be permanently 
removed by nux-vomica given during the interval. 

When impotence is due to mere relaxation and atony of the erectile 
apparatus, and is not dependent on organic defects, the preparations of 
nux-vomica are indicated and are useful. Incontinence of urine, when 
due to a paralytic state of the sphincter, may sometimes be cured by 
strychnia. Nocturnal incontinence, which is most successfully treated 
by belladonna, ergot, and iodide of iron, is sometimes not relieved by 
these agents, when strychnia may be tried. The author cannot state 
with precision the cases in which it succeeds, but it has appeared to 
him most successful in those cases dependent on simple atony of the 
bladder, associated with general laxity of fibre. 

The most important uses of nux-vomica and its alkaloids are in the 
treatment of nervous affections, chiefly in paralysis. It may be used 



318 EXCITO-MOTORS. 

with advantage in hemiplegia, when sufficient time has elapsed to per- 
mit repair of the damage done by the extravasation. It is improper to 
use strychnia during the period of " early rigidit}'," and it is without 
avail in cases of " late rigidity " of the paralyzed members. It is most 
useful when the paralyzed members are completely relaxed. It is use- 
less when the paralysis has existed so long that the muscles have under- 
gone fatty degeneration, so that they no longer respond to a faradic or 
slowly-interrupted galvanic current. Even if the necessary conditions 
as respects the state of the muscles are present, strychnia is inadmis- 
sible in cases of paralysis of cerebral origin when there are vertigo, head- 
ache, and tinnitus. 

In paraplegia of reflex origin, in rheurnatismal paraplegia, in syphi- 
loma of the spinal meninges, paraplegia continuing after the removal 
of the deposits, strychnia is a most serviceable remedy. 

The best results are obtained from the use of strychnia in local 
paralysis, in lead-colic and constipation, and in drop-wrist, in mercu- 
rial and paludal palsies, in rheumatismal paralyses — for example, fa- 
cial paralysis, from exposure of the face to cold — torticollis, spinal 
curvature, from paresis of the muscles on one side, etc. 

In certain forms of spasms strychnia sometimes achieves most im- 
portant results. The evidence which has been accumulated as to the 
curative power of strychnia in tetanus is certainly very conclusive. In 
this disease it should be given so as to substitute the strychnic for the 
traumatic tetanus, but the symptoms induced should not exceed those 
due to a full medicinal dose. Strychnia is most successful — as indeed 
are all the appropriate remedies — in the more chronic cases of tetanus, 
and in those of spontaneous rather than traumatic origin. 

Trousseau's experience is strongly in favor of the use of strychnia 
in the treatment of chorea. The method which he has pursued does 
not commend itself — it is heroic, and indeed unsafe. It consists in the 
use of such doses, beginning with one dose a day and increasing them 
until stiffness of the muscles of the neck, spasmodic jerkings, and a 
" meaningless smile," indicate the beginning of strychnic poisoning. 

Strychnia is a very serviceable remedy in idiopathic or essential 
epilepsy. It is adapted to -pale, anaemic young subjects who have the 
petit mal, as well as the grand mal, and whose attacks are nocturnal. 
It exerts no influence but an injurious one over symptomatic epilepsy — 
that dependent on "coarse organic lesions of the brain." It is said 
that the state of the retinal circulation furnishes an indication for 
strychnia or bromide of potassium, fullness of the retinal vessels be- 
ing an indication for the latter agent, and pallor and anaemia for the 
former. 

In that functional irritability of the nervous system manifested by 
restlessness and wandering neuralgic pains, strychnia affords relief. 

/Spasmodic asthma of nervous subjects, when the paroxysms are 



NTX-VOMIt'A. 319 

due to an irritable state of the nervous system, arc associated with 
rague neuralgic pains, and are determined by physical influences, may 
be bo far influenced by the persistent use of Btryohnia as to occur much 
less frequently. 

Amaurosis of a functional kind, from lead, tobacco, and alcohol, 
may be cured by strychnia. Paralysis of the ocular muscles (proso- 
palgia), of the muscle of accommodation, and paralysis of a single 
muscle, when these affections are due to an arrest of function of the 
nerve or nerves, and do not involve changes of structure, are curable 
by strychnia. Nagcl, however, reports a cure of amaurosis in which 
there existed white atrophy of the optic disks ! 

Iloltenbof points out the kind of amblyopia most benefited by 
this treatment. The cases without serious lesion, those dependent on 
anaemia, on a reflex effect from some part of the trigeminus or sympa- 
thetic, or due to the abuse of tobacco and alcohol, are especially 
amenable to the strychnic treatment. " In central amblyopia," says 
Holtenhof, "without lesion of the macula and with decoloration of the 
temporal portion of the optic disk, I have obtained remarkable im- 
provement by the use of strychnia." Again, when there are lesions 
resulting from deep-seated inflammation of the membranes, improve- 
ment may be hoped for when the primary inflammation has ceased and 
the consecutive atrophy is stationary. In retinitis pigmentosa the 
results produced by strychnia are very striking. In five cases the 
diurnal dimness of vision and the nocturnal blindness were relieved 
considerably, in four cases there ensued an augmentation in the acuity 
of vision, and in two the visual field for white light was enlarged. 
Holtenhof finds strychnia inferior to electricity in the treatment of 
paralysis of the ocular muscles. 

Strychnia has remarkable powers as a respiratory stimulant. Since 
the introduction of Aitken's formula for the phosphate of iron, quinia, 
and strychnia, the fact of its utility in chronic bronchitis, incipient 
phth isis, dilated bronch i, etc., has been distinctly recognized. The good 
effects of this combination are due chiefly to the strychnia. "We pos- 
sess no remedy more generally effective in the vomiting of jrfithisis 
than strychnia. This vomiting is reflex mainly, and occurs at the ter- 
mination of a paroxysm of coughing, but there is also more or less 
stomachal indigestion. As the stomach is emptied, the vomiting inter- 
feres with nutrition. Strychnia has also, as Murrell has shown, some 
power to lessen the siceating of phthisis. This agent may, therefore, 
be regarded as an important remedy in consumption. There are 
several modes of administration, but the best is by solution, the alka- 
loid dissolved in water with a mineral acid : 1$. Strychnia?, gr. j ; 
acid, muriatic, dil., 3 j. M. Sig. Five to ten drops in water three 
times a day. 

Strychnia is one of the antidotes to chloral, as was first shown by 



820 EXCITO-MOTORS. 

Liebreich, but it is not the chief. It may be utilized cautiously as one 
of the means of counteracting the respiratory and cardiac depression, 
but it should not be depended on wholly. 

Nux-vomica has been used with success in the treatment of inter- 
mittents. At present it is rather employed as an adjuvant to quinia, 
than relied on as the sole curative agent. 

Hypodermatic Injection op Strychnia. — This important thera- 
peutical measure needs to be separately discussed. The solution which 
the author advises is as follows : $. Strychniae sulphat., gr. ij ; aquse 
destil. vel aqua3 lauro-cerasi, f j. M. Sig. Five minims contain one- 
forty-eighth of a grain. Some heat is usually necessary to procure a 
perfect solution. 

" The effects of strychnia," as has been well remarked (Echeverria), 
" are widely different when administered hypodermically or by the 
mouth. By the latter method the quantity may be repeated and in- 
creased, unsuccessfully, . . . and yet a smaller dose of the substance, 
exhibited hypodermically, be capable of regenerating at once the lost 
muscular power." 

The indications for the subcutaneous use of strychnia are precisely 
as those given above for its stomach administration : it is contraindi- 
cated in cases of hemiplegia when the injury to the brain has been 
recent. It generally does no good, but harm, when the paralyzed 
muscles are rigid. It is most useful in old cases of hemiplegia, the 
subjects not being advanced in life, the paralysis incomplete, the 
muscles flaccid but not wasted, and having preserved their electro-con- 
tractility. Very remarkable improvement not unfrequently follows 
from this mode of treatment in suitable cases. 

The hypodermatic injection of strychnia not unfrequently is entirely 
successful in curing 'paraplegia, but the limits of its utility are well 
defined. It'is not proper, and is in every way injurious, in acute cases 
involving structural alterations of the spinal cord. In doubtful cases, 
a strychnia-injection may be used as a means of diagnosis between 
structural and functional diseases of the cord ; in the former, the symp- 
toms are increased in definition ; in the latter, they are ameliorated by 
the injection. This mode of using strychnia is curative in reflex para- 
plegia, in paraplegia due to anosmia of the cord, in hysterical paraple- 
gia, and in those cases of paresis of the muscles of the inferior ex- 
tremities due to concussion of the cord, to rheumatism of the meninges, 
and to syphiloma, after the local morbid process has ceased. 

In infantile paralysis, the hypodermatic injection of strychnia is 
an important addition to other means of treatment. If the electro- 
contractility of the affected muscles is not lost, very beneficial results 
may be expected : the injection promotes the capillary circulation, and 
increases the growth and power of the muscles. 

In no form of paralysis is the use of strychnia more conspicuous 



NIX-YOMIOA. 321 

for good than diphtheritic paralysis. Few cases are not promptly bene- 
fited and most are quickly cured. The utility of the subcutaneous 
injection of strychnia has been most signally exhibited in the local 
paralyses; e, g., facial paralysis, aphonia from paralysis of the 
vocal cords; paralysis of the extensors by /cad; paralysis of the 

sphincter vesica}, Of the sphincter a/ii, ore. 

The mode of practising the injection is of considerable importance. 
The solution should be thrown into the substance of the paralyzed 
muscles. For example, in hemiplegia, the muscles in turn, of the para- 
lyzed side, should be pierced by the needle, and the solution dis- 
charged into them. In drop-wrist the extensors should be grasped, 
made tense, and the needle of the syringe be thrust well into them. In 
paralysis of the sphincter ani and prolapse of the bowel, the muscle 
affected should be penetrated by the needle. When the affected mus- 
cles are beyond reach, the injection may be practised at any indifferent 
point. 

Next to the treatment of paralyses, the most frequent application 
of strychnia by the hypodermatic method is in certain ocular mala- 
dies. In the normal condition, strychnia affects the visual functions. 
Hippel first studied these effects, afterward Sandi and Cohn, and sub- 
sequently, in France, Coumetou and Rouire. According to Coumetou, 
strychnia augments the excitability of the retinal elements, increas- 
ing the sharpness of vision, central and peripheral, and also enlarging 
the visual field. He advises its use in amblyopia wdthont lesions, de- 
pendent on functional disorder of the retina, and says it may also, if 
the lesions are not too far advanced, effect favorable changes in chronic 
diseases of the optic nerve and retina. Rouire also agrees with pre- 
vious observers in stating that strychnia affects the optic nerve-fibres, 
increasing the normal acuity of vision and enlarging the visual field. 
He advocates its use in tabetic atrophy, and calls attention to the fact 
that in certain atrophies good results are obtained only by a progres- 
sive increase in the amount administered. In these ocular maladies 
the solution may be injected in the temple, or in the nape of the neck, 
taking the usual precautions against accident. 

In infra-orbital neuralgia, good results have been obtained from 
the subcutaneous injection of strychnia. This practice may be very 
useful in neuralgia characterized by ana?mia and depression. It may 
also be highly serviceable in epilepsy, the cases selected according to 
the rules already defined. 

Authorities referred to : 

Bernard, Cr.. Lccons sur les Effets des Substances Toxiques H Mhlicamcnteuscs, Paris, 
1837. 

Brunton, Dr. T. L. St. Bartholomew's Hospital Reports, vols. sii. and xv. 
Busch, Dr. Berliner klin. Wochcnschrift, No. 37, 1874. 
22 



322 EXCITO-MOTORS. 

CocMETOU, Dr. These de Paris. Strychnia dans la Chirurgie Ocutairc. 

Delioux de Savignac, Dr. Bull. General de Therctp., 1871, January, February, and 
March. 

EcnEVERRlA, Dr. M. Gonz. Treatment of Paralysis by the Hypodermic Injection of 
Strychnia, Connecticut Med. Society, Trans, for 18G8. 

Eulenberg, Dr. Aldert. Lehrbucli der functioncllen Nervenkrankhciten, Berlin, 
1871, p. 450. Also, Hypodermutische Injcclionen. 

Falck, F. A. Archiv fur cxperimcnlelle Pathologic und Pharmacologic, Band iii., p. 
77. 

Freusberg, A. Ibid., Band iii., p, 204 u. 308. Ueber die Wirkung des Strychnins 
und Bermerkungen ubcr die rcficdorische Erregung der Nervencenlrcn. 

Gorochofzeff, N. Deutsche Klinik, xl., 1874, p. 310. Versuche mil Strychnin. 

Holtenhof, Dr. Lyon Medicale. Quoted by Annuaire de Therapcutiquc, 1877, p. 
55, ct seq. 

Haughton, Dr. Samuel. The British Mcdiccd Journal, June 22, 1872, p. 660. Poi- 
soning by Strychnine treated by Nicotine. 

Heinemann, Dr. Carl. Virchow's Archiv, vol. xxxiii., p. 394. 

Hunter, Mr. Charles. Pamphlet- containing reprints of various papers on Hypoder- 
mic Injections. 

Jochelsohn, Dr. On the Influence of Artificial Respiration over Poisoning by Strych- 
nia. London Medical Record, vol. i., p. 82. 

KxAPr, Dr. W. II. The Journal of Nervous and Mental Diseases, vol. v., 1878, p. 
619. 

Leube, Dr William. Archiv fur Anat. und Physiologie, 1867, p. G29. 

Kolliker, Prof. Dr Virchow's Archiv, Band x., p. 239. 

Mayer, Dr. S. Archiv fur experimenlclle Pathologie und Pharmacologic, Band ii., p. 
458 

Nagel, Prof. Dr. Berliner klinische Wochenschrift, vol. viii., p. 6, 1861. 

Schlesinger, Dr. London Medical Record, vol. ii., p. 35. 

SriTZKA, Dr. E. C. Journal of Nervous and Mental Diseases, vol. vi., 1879. 

Vulpian, Dr. Archives de Physiologie, Normale ct Palhologiquc, 1870, p. 116, ct seq. 

Picrotoxine. ' — An active principle obtained from cocculus In- 
dicus. 

Properties. — It is not an alkaloid, although allied to this group of 
substances. It does not combine with acids to form salts. It is neu- 
tral, crystallizable, forming needle-shaped, stellar or foliaceous crystals. 
It is soluble in 150 parts of cold and 25 parts of warm water, and in 
alcohol, and dissolves freely in alkaline solutions. It is unaffected in 
solution by the metallic salts, tannin, etc., and is not precipitated by the 
tests for the alkaloids. It may be administered in pill-form, and can 
be combined with any of the usual so-called nervine tonics. Picrotoxine 
may be administered subcutaneously, in solution in water — one grain 
to | ss — the dose ranging from -g^th of a grain to ^-th of a grain. By 
the stomach it may be given in from -^th of a grain to ^yth. 

Antagonists. — The carefully -conducted researches of Browne 
show that chloral is its physiological antagonist in rabbits and Guinea- 
pigs, and probably will prove to be of value in cases of poisoning in 
man. The anaesthetics, and the motor depressants in general, are an- 
tagonist in respect to its power to produce spasm. 



PICROTOXINE. 323 

Synergists. — All the remedies of this group, notably strychnia, 
brucia, and ergot, increase the effects of picrotoxine. 

Physiological Actions. — The taste of picrotoxine is bitter. It 
increases the flow of saliva. In what form soever administered, more 
or less nausea is produced, when the quantity given is sufficient to 
cause cerebral effects. It is not an irritant to the gastro-intestinal 
mucous membrane ; it increases secretion, and promotes peristalsis, 
but no hyperemia of the mucous membrane has been observed after 
death from a toxic dose. The secretions of the glandular appendages 
of the mucous membrane, probably, also, of the pancreas and liver, are 
decidedly increased, the stools becoming soft and more copious. Ad- 
ministered at any point, picrotoxine diffuses readily into the blood, 
but nothing is known at present of the changes which it induces, if 
any, in the composition of the blood. After death the right side of 
the heart is distended, and the left side incompletely emptied and 
flaccid. The action of the heart varies with the stage of the effects, 
and doubtless, also, more or less according to the size of the dose. At 
first the cardiac movements are slowed, the arterial tension somewhat 
elevated ; during the convulsions the action grows rapid, but, succeed- 
ing the convulsions, and during the stage of coma, the pulse becomes 
slow. According to Planat, by small doses, the cardiac pulsations are 
slowed before the convulsions come on ; then the muscular excitement 
induces rapid action, to be succeeded again by the retarding effects of 
the remedy, increased by the coma. Roeber also finds that the cardiac 
contractions are retarded, and the walls of the heart dilated and flaccid. 
The respiration is also accelerated, and there occurs strong inspiratory 
dilatation, because of spasm of the glottis — effects which are due to 
stimulation of the pulmonary portion of the vagus, and which cease 
on division of this nerve (Roeber). When the convulsions cease, the 
respiration becomes slower and more shallow. No engorgement of 
the lungs is found after death (Browne). 

The pupils are not specifically affected. During the convulsions 
they dilate somewhat, when the tonic spasms come on, and contract 
again during the clonic spasms. The fundus of the eye, examined by 
the ophthalmoscope, exhibits considerable hyperemia. 

The cerebral effects of picrotoxine are variously interpreted. Drow- 
siness, stupor, some muscular trembling, are observed in cold- and 
warm-blooded animals, and have also been experienced in man. A 
heavy, stupid intoxication, with vertigo, incoordination, and dimin- 
ished sensibility, followed by after headache, depression, and nausea, 
are symptoms ascribed to the action of cocculus Indicus in beer sophis- 
ticated by this drug. Restlessness, unsteady gait, and weakness of the 
hind extremities, also, precede the convulsions in animals. Twitching 
of the ears, shaking of the head, and spasms in the eyelids, eyebrows, 
lips, and fore-paws, now come on. Then follows a distinct tonic con- 



324 EXC1TO-M0TORS. 

vulsive stage, with opisthotonos, or einprosthotonos, tetanic fixation 
of the muscles of respiration, cyanosis, and stertor. This tetanic stage 
is succeeded hy the general clonic convulsions, and the seizure is ter- 
minated by a temporary paralysis and coma. In the order and suc- 
cession and character of phenomena, a remarkable similarity in the 
actions of pici'otoxine to the epileptic paroxysm must be discerned. 
By Roeber the convulsions are referred to the effects of the poison on 
the medulla. He finds that, after destruction of the brain, the symp- 
toms are the same as before ; after destruction of the optic lobes, the 
convulsions are less violent ; but when the medulla is removed the con- 
vulsions do not occur, and a large dose causes coma only. These facts 
indicate that picrotoxine acts on the spasm and vagus centres in the 
medulla, and on Setschenow's inhibitory centre. Planat, Chirone, and 
Testa, also hold that this agent acts on the cerebellum, medulla, and 
spinal cord, and leaves the brain exempt. Against these opinions we 
have the carefully-considered but still hypothetical view of Browne, 
who finds in Ferrier's cortical centres the real seat of the action of 
picrotoxine. That the centre, and not the periphery, is the place where 
the action of the poison is expended, seems proved by the studies of 
Roeber, who finds that the electrical reactions of nerve and muscle 
remain unaltered. 

The action of the heart is arrested in the diastole, and, while the cav- 
ities are full, the capillaries at the periphery are empty. The vascular 
lesions, post mortem, are similar to those of epilepsy. That some of the 
poison is yet in the blood, is proved by the fact that flies eating it arc 
poisoned. Elimination probably takes place by the various channels 
of excretion, but chiefly by the kidneys. The skin is powerfully acted 
on, and hence picrotoxine ranks among the most active diaphoretics. 
The urinary excretion is also increased, but more exact observations 
are needed on these points. 

Therapy. — Picrotoxine will, probably, be found very useful in 
cases of torpor of the intestines, dependent on deficient secretion and 
paresis of the musculai layer. In the night-siceats of consumption it 
has been used with great success by Murrell, who had but one failure 
in twenty cases. He finds that it is best to give the necessary dose at 
night — from y^ grain to -fa. The effect lasts about ten days, when 
the sweating begins again, and the remedy must be repeated. Picro- 
toxine has been used with success in the treatment of epilepsy by Planat, 
Dujardin-Beaumetz, Hurd, and by Hammond. It is more especially 
adapted to the weak and anaemic type. It has been also used with 
success in chorea, and with promising results in paralysis agitans. 
In a case of glosso-labio-laryngeal paralysis Gubler obtained a notable 
amelioration. Further experiences with these diseases are much need- 
ed. It is probable that this remedy may be applied with advantage 
to the treatment of other paralyses. According to Tschudi, it has 






ERGOT. 325 

been given in paralysis of the sphincters with good results. The 
tremors of chronic alcoholism have, it is said, been removed by it. 
One of the forms of sick-headache — that occurring at or about the 
menstrual period — is sometimes greatly relieved by its timely exhibi- 
tion. An ointment of picrotoxine — ten grains to an ounce of simple 
ointment — has been applied with success to the treatment of parasitic 
Skin affections. Care is necessary, and abraded surfaces must be 
avoided. 

A saturated tincture of cocculus Indicus might be employed in place 
of picrotoxine. Planat recommends a tincture composed of one part 
of the berries to four parts of alcohol, and of this one drop is the ini- 
tial dose, morning and evening, increased daily by the addition of two 
drops, up to sixty or seventy drops for an adult, daily. In the diseases 
for which it is prescribed, it is necessary, to secure curative effects, that 
the physiological action be produced. Planat has used this tincture 
successfully in chorea, epilepsy, eclampsia (infantile), and in painful 
contractures of the extremities. Gubler advises the dose of a mille- 
gramme of picrotoxine for subcutaneous use. He has observed that 
indurated spots result from the injections, but they slowly disappear. 

Authorities referred to : 

Browne, Dr. Crichton. The British Medical Journal, vol. i., 1875, pp. 409, 443, 
476, 540. 

Chirone and Testa. Annali. Univ. di Med. e Chirurg. Quoted in London Med. 
Record, October 15, 1880. 

Dujardin-Beaumetz. Annuaire de Therap. for 1876, p. 33. 

Gubler, Prof. A. Bull. General de Therap., 1875. 

Hammond, Dr. W. A. St. Louis Clinical Record, October, 1876. 

IIcrd, Dr. Michigan Med. Kerns, February 10, 18S1. 

KbriLER, Prof. Dr. Bed. Min. Wochcnschrift, No. 47, 1867. 

Murrell, Dr. William. The Practitioner, October, 1879, vol. xxiii., p. 241. 

Planat, Dr. Bull. Gen. de Therap., 1876. Also Annuaire de Therap., 1876, p. 29. 

Boeder, Dr. Archivf. Physiol, etc., for 1869, p. 30. 

Ergota. — Ergot. The sclerotium of claviceps purpurea, replacing 
the grain of secale cereale. Ergot de seigle, Fr. ; Mutterkom, Ger. 
Extraction Ergotce Fluidum. Fluid extract of ergot. Dose, 3 ss 

— §]•_ 

Vinutn Ergotm. — "Wine of ergot. Dose, 3 i — 1 ss. 

Ergotin. — This preparation must not be confounded with a con- 
stituent of ergot, supposed to be an active principle. The ergotin of the 
shops is simply an aqueous extract. It varies very much in strength, 
owing to faulty modes of preparing it, and, as found in the shops, is 
not unfrequently inert. As prepared by Squibb it is entirely soluble 
in water, and represents the powers of the drug. Ergotin is the most 
eligible preparation for hypodermatic injection. From one to five 
grains may be injected at one time. In preparing it for this purpose, 



32G EXCITO-MOTORS. 

the quantity to be injected should be rubbed up with fresh distilled 
or rain water, and then passed through the filter. It is always better 
to prepare it whenever required. If it is necessary to preserve the 
solution, the addition of a little carbolic acid — one grain to four ounces 
— will usually suffice. The addition of glycerine is not necessary, 
unless added as a preservative fluid ; and is objectionable, because it 
greatly increases the pain which attends the subcutaneous injection. 

Composition. — Some confusion yet exists in regard to the con- 
stituents of ergot, notwithstanding recent advances in our knowledge. 
An unfortunate nomenclature is in part responsible for the confusion ; 
but the complexity of the subject and the conflicting views of chemists 
are the chief causes of the present condition of the pharmaceutical 
knowledge of ergot. The present state of the subject is as follows : 

Ergot contains about thirty per cent, of a saponifiable, non-drying 
oil, with which is associated a small quantity of resin and cholesterine. 
When extract of ergot is treated with an alkali, a peculiar fishy odor 
is developed, due to methylamine, according to some authorities, and 
trhnethylamine according to others. Ergot, also, contains lactic and 
phosphoric acids and phosphates. The two principles ecbolina and 
ergotina, separated by Wenzell in 1864, are not true alkaloids of ergot, 
and are said by Dragendorff to be identical. In 1830 a supposed al- 
kaloid was obtained by Wiggers, which he named ergotin, but this is 
not the true active principle. Unfortunately, an aqueous extract, pre- 
pared by Bonjean, was also named ergotin. Kohler has examined the 
ergotin of Wiggers and that of Bonjean, and finds that they are 
mixtures : the former containing the ingredients of ergot not soluble 
in w T ater ; the latter, those that are soluble in water. According to 
Kohler, neither of these so-called ergotins represents the properties of 
ergot. More recently Dragendorff and Podwissotzky have gone over 
the chemistry of ergot anew T , with different results. They have in- 
troduced new terms also, which add to the complications. The most 
important principles obtained by them are sclerotic or sclerotinic acid, 
and scleromiccin, the former existing in good ergot in the proportion 
of about four per cent., and the latter, two to three per cent. They have 
also separated other principles and secondary products, named re- 
spectively sclererythin, scleroiclin, scleroxanthin, and sclcrocrystattin. 
Another alkaloid has lately been discovered by Tanret, to which he 
has given the name ergotininc. This substance seems to be the nearest 
approximation to a genuine alkaloid of any hitherto proposed. It is 
a white, crystallizable solid, insoluble in water, and soluble in ether and 
chloroform. It is alkaline in reaction and has strong basic proper- 
ties, and combines with acids to form salts. It is an unstable sub- 
stance, and in the air soon decomposes. 

Antagonists and Incompatibles. — The caustic alkalies and the 
metallic salts are chemically incompatible. Aconite, veratrum viride, 



ERGOT. 327 

tobacco, lobelia, etc., antagonize the action of ergot on the circula- 
tion. 

Synergists. — Electricity, cold, digitalis, belladonna, are synergistic 
as regards the vascular system. Savin, gossypium, rue, borax, increase 
its parturient action. 

Ustilago Maidis.— Com ergot. 

Composition. — There is a great similarity in the composition of 
this substance and the ergot of rye. An important constituent is 
propylamine, and it contains also the so-called secalin, a thick, viscid 
oil, resin, and some other unimportant ingredients. 

As it corresponds to ergot of rye in its chemical constitution, it is 
in a high degree probable that it possesses similar physiological effects. 

Preparations. — The most eligible preparation is the fluid extract. 

Extractum TJstilaginis Maidis. — Fluid extract of ustilago. Dose, 
m. xx — 3 i j. Each minim is equivalent to one grain of the crude drug. 

The clinical evidence is strong that the corn ergot possesses the 
same properties as the rye ergot, and is applicable to and has been 
used in the same forms of disease. If further experience confirms these 
observations, a most desirable addition to the resources of the materia 
medica will be made. It occurs in larger quantity, is more readily 
obtained, and will be less sophisticated than the corresponding rye 
preparation. 

Physiological Effects. — In small medicinal doses ergot does not 
produce sensible physiological effects. In large doses it produces 
symptoms referable to the gastro-intestinal canal, and to the cerebro- 
spinal axis. It is bitter to the taste, and excites more or less heat and 
dryness of the throat, followed by thirst, stomach-pain, vomiting, intes- 
tinal pain, and occasionally pm-ging. These gastro-intestinal symp- 
toms are unquestionably due to the local irritant action of the drug ; 
for, after death, in a few fatal cases which have resulted from its ad- 
ministration, there have been found patches of inflammatory redness 
in the stomach and intestines. 

The active constituents of ergot diffuse into the blood. What 
changes, if any, are caused in the composition of the blood, are at 
present quite unknown. Very characteristic effects are, however, pro- 
duced in the circulatory system : the action of the- heart becomes slower, 
and an enormous rise takes place in the blood-pressure. This influence 
on the circulatory system modern research has shown to be due to the 
action of ergot on the vaso-motor nervous system ; it increases the ac- 
tion of this system, and causes a contraction of the arterioles. 

The dilatation of the pupil which follows is another evidence of 
this action. Pain in the head (usually frontal), dimness of vision, 
giddiness, and stupor, are also produced by it. The action of ergot on 
unstriped muscular fibre is further shown in the contractions of the 



328 EXCITO-MOTORS. 

parturient womb, the arrest of haemorrhage, and the difficulty of mic- 
turition, which follow its medicinal administration. The power of 
ergot to contract the arterioles has been repeatedly demonstrated in 
the web of the frog's foot. 

The phenomena above described, due to the administration of large 
medicinal or toxic doses, are known as acute ergotism. The peculiar 
morbid effects of ergot, when used for a long period of time as food 
(diseased grain), are known as chronic ergotism, which exists in two 
forms, the convulsive and gangrenous. Generally the convulsive form 
begins by vertigo, disorders of vision, tinnitus auriurn, numbness of 
the fingers and toes, and afterward of the integuments of the body. 
These symptoms are followed by tetanoid contractions of the fingers, 
of the forearms on the arms, and of the arms against the chest ; of the 
toes on the palmar surface of the foot, of the leg on the thigh. The 
thoracic, abdominal, and diaphragm muscles are also tetanically con- 
tracted, and respiration becomes painful and difficult, and attacks occur 
similar to asthma. The intestinal muscles become affected by cramp, 
doubtless tetanoid in character, colics ensue, and diarrhoea ; the uterus 
in pregnant females takes on action, and abortion may result. The 
pulse is small, action of heart slow, and the surface cold. The appe- 
tite is generally ravenous. 

The tetanic spasms, at first separated by distinct intervals, become 
continuous, and opisthotonos or emprosthotonos is produced. Anaes- 
thesia (complete) of the surface succeeds to the tetanoid attacks, and 
gangrene of limited spots may occur. The organs of sense lose their 
sensibility and taste, hearing and smell are abolished. The pupils are 
dilated, sometimes unequal, and various disturbances of vision ensue. 
Epileptiform convulsions may occur in addition to the tetanoid spasms, 
delirium sets in, and complete insensibility at last supervenes. 

As has been shown by Lasegue and Tardieu, the gangrenous and 
convulsive forms of chronic ergotism are not separated by any well- 
marked pathological differences. The gangrenous form begins by 
tingling, numbness, formication, an insupportable sense of fatigue in 
the members, an earthy hue of the skin, coldness of the surface ; 
nausea, vomiting, and diarrhoea, with intestinal cramps, then occur ; 
muscular contractions take place ; an eruption of vesicles filled with a 
dark ichorous fluid appears on one or more extremities, and gangrene, 
dry or moist, quickly destroys the toes, the legs, the nose, or other 
parts. 

The phenomena of chronic ergotism are evidently due to two causes 
— to the dyscrasia which exists in the subjects of this malady, owing 
to insufficient food and bad hygienic surroundings, and to the action 
of the ergot of the diseased grain, in diminishing the blood-supply to 
the cerebro-spinal axis, to the vegetative organs, and to the skin and 
muscular system. 



ERGOT.' 329 

To tins general sketch of the actions of ergot, it may he well to 
add some particulars of its most important physiological properties, 

and some observations on the actions of the recently discovered active 
principles. The most conspicuous effect of ergot, and that on which 
depends its therapeutical applications, is the influence which it exerts 
over the vascular apparatus. It is an undoubted fact, in respect to 
which all the investigators agree, that ergot diminishes the number 
and alters the character of the cardiac pulsations. The frog's heart 
may be arrested in the diastole by the intravenous injection of a full 
dose. By Rossbach and Wernich it was observed that a vermicular 
or peristaltic motion was given to the heart of frogs. The arrest of 
the heart's action is attributed by Eberty to stimulation of the vagus 
and a consequent increase of the inhibition. By Rcssbach it is referred 
to an action on the cardiac muscle. It is in a high degree probable, 
however, that the slowing and depression of the cardiac functions is 
due to the action of ergot on the cardiac ganglia. To this may be 
opposed the observation of Willebrand, that the normal or hypertro- 
phied heart so contracts under the action of ergot that the difference 
in size is appreciable by percussion ! There is no dispute in regard to 
the contraction of the arteries induced by ergot. It has been observed 
and measured by Wernich, Briesemann, and Holmes. The notion that 
ergot causes contraction of the arteries by stimulating the vaso-motor 
system and its muscular apparatus, has long been entertained. An 
enormous rise in the blood-pressure has been stated to occur by Eberty, 
Kohler, and H. C. Wood, and their opinion was based on kymographic 
observations. Holmes, Hermann, and Wernich, on the other hand, 
maintain that the blood-pressure is actually reduced. Wernich shows 
that the veins are dilated, and that a great accumulation of blood takes 
place in them, while, at the same time, the arteries contract, not re- 
ceiving from the slowly acting heart sufficient blood. The contrac- 
tion of the arteries is not, therefore, an active contraction, as has been 
supposed, but a collapse, the result of deficient supply of blood, which 
has accumulated in the dilated veins. By the theory of vaso-motor 
stimulation, it was easy to explain the action of ergot on the muscular 
fibre of the uterus and intestinal canal. If, however, the blood-press- 
ure falls after the administration of considerable doses, as Handelin, 
Brown-Sequard, and others affirm, and the arterial contraction is 
not active, how explain the uterine and intestinal action of ergot ? 
This result is due to arterial ansemia (Wernich, Schlesinger, Mayer, 
etc.). It is now clearly established that active movements occur in 
the muscular fibre of the intestinal canal and uterus by inducing an 
arterial anaemia. According to this view, then, the active peristalsis 
and the uterine contractions which follow the exhibition of ergot are the 
result, not of a direct stimulation of the sympathetic system, but of the 
diminished cardiac energy, dilatation of the veins, and arterial anaemia. 



330 EXCITO-MOTORS. 

The action of ergot is not limited to the vascular apparatus. The 
arterial anaemia which it induces may serve to explain the cerebral 
effects which follow its free administration in man, but, besides these, 
the functions of the spinal cord and peripheral nerves undergo changes. 
In frogs ergot induces paralysis, beginning in the hind extremities, 
and thence involving all parts, the circulation and respiration being 
the last to yield. In warm-blooded animals the same effects are pro- 
duced, and, if the action continues, finally the cardiac and respiratory 
centres are paralyzed. By Zweifel these central effects are held to 
be the principal, and all others, merely secondary. On the other hand, 
the depression in the motor and reflex functions of the cord may be 
explained by the arterial anaemia, which is an undisputed effect of 
ergot, how much soever the mechanism of its production may be dis- 
puted. Indeed, it must be admitted that the actions of ergot are still 
subjudice. The numerous and often diverse views which have been 
expressed may be in part explained by the character of the prepara- 
tions. There can be no doubt that the active constituents are un- 
stable, and hence the pharmaceutical products vary, not only in the 
degree, but decidedly also in the character of the actions. In Koh- 
ler's investigation, in which he compared the ergotin of Wiggers and 
Bonjean, there were very wide differences between them. The ergotin 
of Bonjean — an aqueous extract — excites the vaso-motor centre in the 
medulla and the cardiac inhibitory centre, and very large doses para- 
lyze the heart, the muscular tissue losing its excitability to galvanism. 
Wiggers's ergotin has no effect on the vascular apparatus. In these ex- 
periments of Kohler, with which Eberty was associated, the power of 
ergot to increase the blood-pressure is an important point. The atten- 
tive reader will observe that in these experiments the heart was para- 
lyzed, and the irritability of its muscular tissue destroyed. Wiggers's 
ergotin causes cramps of the intestines, and violent inflammation of 
the gastro-intestinal mucous membrane, effects which never result 
from Bonjean's. Both kinds of ergotin lower the temperature, and 
both retard the respiration. Bonjean's ergotin diminishes the irri- 
tability of the pei'ipheral motor nerves, and Wiggers's increases it. 
Both lessen the irritability of the sensory nerves. Kohler concludes 
that, when it is desired to slow the heart, contract the vessels, dimin- 
ish reflex actions, and lessen temperature, the ergotin of Bonjean 
should be used. 

The physiological action of sclerotinic acid has been carefully 
studied by Nikitin in Rossbach's laboratory. He starts out by affirm- 
ing the identity of action between this principle and ergot. In frogs 
the reflex excitability of the spinal cord is reduced, then destroyed, 
but in warm-blooded animals it is reduced only. It does not affect 
the irritability of the motor nerves, nor the contractility of the mus- 
cles, but when brought in contact with sensory nerves, paralyzes them. 



ERGOT. 331 

Sclerotinic acid depresses the action of the heart in frogs, hut not in 
mammals. In toxic doses it lowers the hlood-pressure and reduces the 
temperature. The respiration is slowed, and, when toxic doses are 
given, the movements of respiration cease before the heart stops. The 
peristaltic movements are increased in warm-blooded animals, and the 
uterus, whether gravid or not, is excited to action. Death is due to 
paralysis of respiration. 

Sclerotinic acid has been freely prescribed by Von Hoist, who finds 
it possessed of a high degree of activity, but other clinicians have 
been less successful — thus Robert, of Halle, finds it cannot be substi- 
tuted for ergot. In my own experiments, I have found it produce 
effects, but not those of ergot proper. Sclerotinic acid is separated by 
alcohol, but Handelin, who had investigated this subject under the 
superior direction of Schmiedeberg, finds that ergot loses none of its 
activity by being extracted with alcohol. Handelin's experiments, 
made with an aqueous extract, present some points of interest. He 
found that small doses cause anaesthesia and impair the power of 
coordination, and large doses paralyze reflex and voluntary motions. 
As the peripheral nerves are unaffected, the paralysis is centric. Small 
doses lower the blood-pressure temporarily, and large doses perma- 
nently. The pulse is at first quickened, and then declines, becom- 
ing more and more slow until the heart is arrested. 

The first trials with Tanret's crystallized ergotinine were made by 
Dr. Mole, who found it as effective in uterine haemorrhage as ergot. 
The amount that he administered did not exceed four milligrammes 
in twenty-four hours. Galippe and Budin have also experimented 
with ergotinine on frogs, cats, and dogs, and produced many of the 
effects ascribed to ergot, namely, slowing of the pulse, reduction of 
temperature, paralysis, and convulsions. Peton, another investigator, 
has also experimented with ergotinine, the results of the action being 
contraction of the arteries, restlessness, trembling, diarrhoea, etc. 

An examination of the results obtained from the experimental and 
clinical trials with the so-called principles and alkaloids of ergot, de- 
monstrates that in no single one are contained all the powers and prop- 
erties of the drug. It is also evident that ergot, and those principles 
possessing its powers most nearly, depress the heart, and lower rather 
than elevate the tension of the arteries. The contraction of the ar- 
teries is not, therefore, an active contraction ; and, as the blood ac- 
cumulates in the veins, there is an anaemia of the cerebro-spinal axis 
and of the organic muscular fibre. To this condition of things may 
be referred the phenomena resulting from the exhibition of ergot. 

Therapy. — The only diseases of the intestinal canal to which ergot 
is applied are chronic diarrhoea and dysentery. It is best adapted to 
those cases in wdiich the chronic succeeds to the acute form, and is not 
so serviceable in the chronic diarrhoea of warm climates, which has de- 



332 EXCITO-MOTORS. 

velopecl slowly, without preliminary acute symptoms, rj . Ext. ergotae 
fluidi, 3 iijss ; tinct. opii deodor., 3 ss. M. S. A teaspoonful three 
times a day. PJ. Ergotinse (aq. ex.), 3j ; ext. nucis vomicae, gr. v ; 
ext. opii, gr. x. M. ft. pil. no. xx. Sig. One every four or six hours. 
This last prescription is highly useful in persistent chronic diarrhoea. 

Dr. L. G. Andrew has treated acute dysentery successfully with 
the fluid extract of ergot. Dr. W. C. Dahney, of Virginia, urges the 
local application of fluid extract of ergot in affections of the mucous 
membrane, characterized by enlarged vessels, as, conjunctivitis, cer- 
vicitis, pharyngitis, etc., and by Dr. Eldridge it has been applied to 
the treatment of gonorrhoea, acne rosacea, etc. The theory of its ac- 
tion in these maladies is the artificial anaemia which it induces in the 
arterial vessels. Inflammation cannot go on because the blood supply 
is inadequate. In the local application the fluid extract of ergot is 
used. In most cases this may be applied directly to the membrane 
undiluted. The aqueous extract, or ergotin, may be utilized for these 
purposes also ; made into a paste more or less thick according to the 
character of the surface, it may be plastered on the affected part. 

Ergot in the form of the fluid extract, with or without nux-vomica, 
will often arrest the bleeding of ha-morrhoids, and .cause such a con- 
traction of the vessels in recent cases as that the symptoms may en- 
tirely disappear. This treatment is especially serviceable in the haemor- 
rhoids which succeed to delivery. Relaxation of the sphincter ani and 
prolapsus of the rectum may be ameliorated and, when recent, cured 
by the same means. 

Ergot is a useful remedy in cases of enlarged heart (dilated cavities) 
without valvular lesion. It may be given with digitalis: r£. Ext. 
ergotse fluidi, 3" iijss ; tinct. digitalis, §" ss. M. Sig. A teaspoonfid 
three times a day. There is now no longer any doubt as to the value 
of ergot in aneurisms, and especially in internal aneurisms beyond the 
reach of surgical treatment. In these cases the methodus medendi is 
as follows : ergot slows the action of the heart, and causes such a de- 
gree of contraction of the arterioles as to produce a great increase of 
the blood-pressure, whence it follows that the coagulation of the blood 
in the aneurismal sac is greatly promoted. It is quite conceivable that, 
as respects small aneurisms of the peripheral main arterial trunks, 
ergot may effect a cure in the mode suggested by Langenbeck, viz., 
by direct contraction, under the influence of the ergot, of the unstriped 
muscular fibres in the affected portion of the vessel. With the use of 
srgot should be enjoined rest in the recumbent posture, and other 
measures to favor hyperinosis and the coagulation of the blood in the 
aneurismal sac. 

The recent, more accurate notions, regarding the physiological action 
of ergot, have led to its employment in various forms of hemorrhage. 
With suitable means for improving the quality of the blood, ergot is 



Vi 



ERGOT. 333 



very serviceable in the hcemorrhagio diathesis; but it is not to be 
relied on alone. The special indication for its use in haemorrhage is a 
want of tonicity of the vessels. It is used in epistaxis, haemoptysis, 
ratal, intestinal and uterine haemorrhage. Large doses of a suitable 
preparation are necessary ; for, if the drug be inert, nothing but disap- 
pointment will be experienced from its use, and small doses do not pro- 
duce sufficient effect. From half a drachm to a drachm of the powdered 
ergot, or one to two drachms of the fluid extract, given every half-hour 
or hour, will be necessary in urgent cases. As powdered ergot rapidly 
loses its activity by keepings the fluid extract should be used, and only 
that prescribed which has been carefully made from the fresh drug. 
Attention to these precautions will insure more uniform results in 
haemorrhage than have hitherto been obtained. In haemoptysis the 
fluid extract of ergot may be given with other appropriate remedies : 
IjL Ext. ergotse fluidi, 3 iij ; ext. ipecac, fluidi, tinct. opii deodor., aa 
3 ss. M. Sig. A teaspoonful every half-hour or hour. When the 
spula are heavily charged with blood, and there is no denned haem- 
orrhage, the following may be used : IjS. Ergotinas (aq. ex.), 3j; pulv. 
ipecac, gr. x; acid, gallic, 3j. M. ft. pil. no. xx. Sig. One every 
hour or two. In renal haemorrhage, the following is a useful formula 
and generally very effective : ]$. Ext. ergotse fluidi, tinct. kramerise, aa 
5 ij. M. Rig. A teaspoonful every hour or two. Or, ergotine may be 
prescribed with gallic acid, as in the prescription above given. 

The indication for the use of ergot in menorrhagia is the existence 
of large, spougy uterus — the condition of things which depends on 
subinvolution of the womb. Menorrhagia, when caused by ovarian 
excitement, is usually more promptly relieved by bromide of potassium, 
and metrorrhagia, produced by fibroids or fungous granulations, is, in 
the author's experience, much more decidedly held in check by diluted 
sulphuric acid than by ergot. 

When there is reason to believe that vertigo, ep>istaxis, headache, 
and tinnitus aurium, are due to miliary aneurisms of the intra-cranial 
arterioles, most favorable results can be produced by the use of ergot. 
Also, when there is a sluggish and partially obstructed state of the in- 
tra-cranial veins, usually due to chronic arteritis, and accompanied by 
hebetude of mind, giddiness, ejustaxis, etc., these symptoms are made 
to disappear, and the mental condition is much improved by ergot. 

Dr. Crichton Browne, a jjhysician of large experience in these dis- 
orders, finds ergot a very useful remedy in certain forms of mental 
disease, for example, "in recurrent mania, chronic mania with lucid 
intervals, and in epileptic mania" In these mental disorders he as- 
sumes the existence of cerebral byperaemia, and he deduces the cura- 
tive value of ergot from its power to cause contraction of the vessels. 

Migraine, when the attacks are accompanied by suffusion of the 
face, injected conjunctiva?, and a full pulse — the congestive form is 



334 EXCITO-MOTORS. 

cured by ergot, and Dr. Kitchen indeed extends its use to almost all 
kinds of headache. 

In epidemic cerebrospinal meningitis, ergot is one of the remedies 
from which the best results are to be expected. In congestion of the 
spinal meninges and the cord, and in acute myelitis, this remedy has 
probably been more uniformly successful than any other, but it must 
be given in large doses. > 

Excellent results have been obtained from the use of ergot in acute 
inflammation of the conjunctiva, in blepharitis, and in the phlyctenular 
ophthalmia of children. 

The long-continued use of ergotine has achieved remarkable results in 
chronic metritis. Uterine fibroids and polypi of the uterus are greatly 
benefited in two modes by ergot : uterine action is set up, by which the 
growth is either compressed or extruded, and the nutrient vessels are 
so diminished in calibre that atrophy of the morbid growth occurs. 
The numerous reported instances of success by this treatment, and the 
author's personal experience of its utility, justify him in urging a trial 
of this remedy in uterine fibroids and polypi. 

In congestive dysmenorrhcea, much good may be expected from the 
use of ergot when the menstrual molimen begins. IJ. Ext. ergotae 
fluidi, 3 vij ; tinct. gelsemii con., 3 j ; tinct. aconiti rad., gtt. xvj. M. 
Sig. A teaspoonful every two, three, or four hours. Amenorrhoza, when 
dependent on plethora, has been cured by ergot. 

When incontinence ofurine, nocturnal or diurnal, is caused by a 
paretic or paralytic state of the sphincter vesicaz, relief may be confi- 
dently expected from the use of ergot. The fact that one of the ill- 
results of the administration of ergot in large doses is an inability to 
void the urine, is an interesting explanation of the methodus medendi 
of ergot in these cases. 

Ergot is one of the most satisfactory remedies in the treatment of 
spermatorrhoea. It is not useful when the losses are due simply to 
plethora. Its curative value is especially exhibited in those cases in 
which the erections are feeble and infrequent, the intromittent power 
wanting, and the testes relaxed and deficient in secretory activity. 

Paralysis of the bladder, the result of over-distent ion, and occasion- 
ally when due to cerebral or spinal lesion, is greatly benefited or cured 
by ergot. 

Ergot was first employed by Da Costa in the treatment of diabetes 
insipidus, and a number of cases have been cured by Murrell, Saun- 
ders, and others. The remedy must be perseveringly used, and in full 
doses, up to the stomach capacity or evidence of physiological action. 

Ergot iist Obstetric Practice. — It is no longer a matter of doubt 
that ergot promotes uterine contractions ; that it originates them with- 
out previous effort of the womb, is questionable. The contractions due 
to ergot differ from the spontaneous, natural contractions, in being less 



ERGOT. 886 

rhythmical and more tetanic. 'When large doses of ergot are used, a 
continuous expulsive effort may be produced. Ergot is indicated in 
labor when there is uterine inertia, the first stage being completed, and 
no obstacle existing at the outlet. If given before dilatation is com- 
pleted, the perinseum rigid, and the ostium vaginal not relaxed, disas- 
trous consequences may ensue, both to mother and child. On the part 
of the mother, the violent and continuous pains — the resistance in front 
remaining — may cause a rupture of the womb, or the resistance may be 
overcome by laceration of the perinseum. On the part of the child, it 
arrests hasmatosis, partly by direct action on the placental blood, and 
partly by the continuous compression of the body ; but the chief danger 
is paralysis of the foetal heart. 

It is highly approved by obstetricians at the present time to admin- 
ister a dose of ergot at the conclusion of the second stage of labor, to 
insure firm uterine contractions. This practice is held to be the more 
necessary when previous experience justifies the apprehension of trou- 
blesome haemorrhage. When post-partum haemorrhage occurs it is uni- 
versally conceded to be the proper thing to administer a full dose of 
ergot ; but at the same time other measures must be resorted to in 
order to procure firm uterine contractions, on which alone depends the 
safety of the patient. In these conditions the ergot is usually admin- 
istered in substance — one scruple to a drachm, of coarsely-powdered 
ergot, infused in a cup of hot water, the whole being drunk by the pa- 
tient. From 3 j to 3 j of the fluid extract may be given instead — the 
officinal preparation representing a grain of ergot to the minim. 

The Hypodermatic Injection op Eegotine. — The subcutaneous in- 
jection of ergot has become so important a therapeutical resource that 
it is necessary to treat the subject in a separate division. The solution 
employed for this purpose is usually as follows : $. Ergotinag (aq. ex.), 
3 j ; glycerinae, 3 j ; aquse destil., 3 vij. M. Sig. Eight minims con- 
tain one grain of ergotine. Squibb has prepared "an extract of ergot 
which is almost entirely soluble in cold water, and represents good rye 
ergot in the proportion of one grain of extract for five grains of ergot. 
Sixty grains of this extract, dissolved in two hundred and fiftj' minims 
of water — the solution filtered, and made up to three hundred minims 
by passing water through the filter to wash it and the residue upon it — 
makes a solution which represents ergot in the proportion of minim for 
graiu, and is of the same strength as the fluid extract of ergot, but is 
free from alcohol or other irritant substance." When the aqueous ex- 
tract of ergot of good quality cannot be obtained, the fluid extract may 
be used. 

The rules for the administration of ergot are the same as for other 
agents applied in this way. 

In the treatment of hemorrhage, when a prompt effect is desired, 
the hypodermatic injection is preferable to the stomach administration. 



336 EXCITO-MOTORS. 

In haemoptysis, the injection may be practised while suitable remedies 
are administered by the stomach. In hcematemesis, especially if the 
stomach be irritable, better results may be obtained by subcutaneous 
use of ergotin than by any form of intestinal medicine. In post-partum 
haemorrhage, when to await the action of ergot may endanger the life 
of the mother, the subcutaneous administration should be resorted to. 
The happy results which have attended this mode of administration, in 
serious cases, demand that the accoucheur be provided with the neces- 
sary appliances for the hypodermatic injection of ergotine in every ob- 
stetrical case. This mode of using ergot is not only prompter in results 
but is more effective in securing uterine contractions and arrest of hasm- 
orrhage. 

The good results which are obtained from the stomach administra- 
tion of ergot, in subinvolution of the uterus and in chronic metritis, are 
much more quickly and decisively obtained from the subcutaneous ad- 
ministration. Since the memoir of Hildebrandt appeared, numerous 
cases of successful treatment of uterine fibroids by hypodermatic injec- 
tion of ergotine have been published. There seems to be no longer any 
doubt that this agent administered in this way, and less effectively and 
for a much longer period by the stomach, also has the the power to ar- 
rest the growth of uterine fibroids, to cause them to atrophy, or to set 
up such a degree of uterine action as to compel their extrusion as poly- 
'pi from the uterine cavity. lb has, of course, long been known that 
ergot administered by the stomach may induce such a degree of uterine 
contraction as to expel a polypus. In those instances in which the hy- 
podermatic injection fails to arrest the growth of a polypus, notable 
improvement in the amount of the haemorrhage and of the muco-puru- 
lent discharge is, at least, a result of the treatment. The author is en- 
abled to speak from personal observation of the excellent results ob- 
tained by this mode of treatment in many cases. 

From two to six grains of the aqueous extract cf ergot (ergotine) 
may be injected under the skin in these cases of uterine fibroids on al- 
ternate days, or thrice or twice each week. The abdomen is usually 
preferred as the site of the injection. More or less pain is experienced 
at the moment of the insertion of the solution, and an indurated spot, 
which may be more or less sore, will remain for a week or more. Sup- 
puration may result from the injection, but it is not a frequent acci- 
dent. 

The hypodermatic injection is an effective mode of treating varicocele. 
About two grains of ergotine in solution is a suitable dose. The needle 
is inserted so that its point will rest among the dilated veins, but care 
must be taken not to puncture a vein. Very severe pain follows, and 
there may be great faintness, but the effects subside in a few hours un 
less considerable swelling should ensue, which is quite usual. A single 
injection may cure a very extensive varicocele, and more than two are 



ERGOT. 337 

rarely necessary. Varicose veins in other parts, especially of the in- 
ferior extremities, have been cured by the same treatment. The follow- 
ing is the mode of proceeding in these cases : the needle is inserted un- 
der the skin, in close juxtaposition to the enlarged vein, and the fluid 
is so injected as to lie alongside of the vein, but not to enter it. The 
cure which follows in many of these cases has been ascribed to the in- 
flammatory swelling which takes place, but there is, doubtless, besides 
this effect, a dynamical influence exerted on the vessel-walls. 

It has lately been asserted that deficient erections and loss of the 
capacity for coitus are not unfrequently due to enlargement of the dor- 
sal vein of the penis, and consequent too rapid emptying of the veins of 
the erectile tissue. Acting upon this plausible suggestion, the author 
has practised the hypodermatic injection of ergotine about the dorsal 
vein of the penis, and he has had apparently excellent results. 

Before closing this article, it may be advisable to recall to the read- 
er's attention the fact that the hypodermatic injection of ergot, or its 
internal administration in large doses, may cause such tonic contraction 
of the sphincter vesica} as to render micturition impossible. Careful 
inquiry and frequent examinations of the hypogastric region should be 
made during a course of ergot preparations. 

Authorities referred to : 

Baillt, Prof. M. Ergot, Ergotine — Action physiologique, etc. Bulletin General de 
Therapeuiique, vol. lxxviii., pp. 433, 481, 529. 

BAivrnor.ow, Dr. Roberts. Manual of Hypodermic Medication, second edition, ar- 
ticle, Ergotine. 

Briesemann, Dr. C. Schmidt's Jahrbiicher, vol. cliii., p. 30. 

Browne, Dr. Criciiton. The Practitioner, vol. vi., p. 321. 

Cyr, Dr. Jules. Traite de V Alimentation, Paris, 1869, article, Ergotisme, p. 425, 
el seq. 

Dutoit, Dr. Schmidt's Jahrbucher, vol. cliv., p. 315. 

Eberty, Dr. P. Schmidt's Jahrbiicher, vol. clviii., p. 126. 

Eulenburg, Dr. Albert. Die hypodcrmatischen Injection der Arzneimittel, 1 867, p. 283. 

Fluckiger and Hanbury. Pharmacographia, p. 672, et seq. 

Hildebrandt, Prof. Uebcr die Einwirkung mbcutancr Injectionen von extr. secal. cor- 
nut. aq. auf Fibro-Myome des Uterus. Berliner Minische Wochenschrift, No. 25, 1872, 
p. 29. 

Holmes, Dr. Ch. L. Schmidt's Jahrbucher, vol. clviii., p. 126. 

Husemann, Drs. Theo. und Aug. Die Pftanzenstoffe ; Alkaloide des Mutlerkorns, p. 
620. 

Husemann, Dr. Theod. Handbuch der gesammten Arzneimittellehre, Berlin, 1875, p. 
i203. 

Kitchen, Dr. Daniel. Tlie American Journal of Insanity, July, 1873. 

Lakgenbeck, Prof. Berliner Minische Wochenschrift, No. 6, 1869. 

Luton, Dr. A. Gazette Hebdomadaire, October, 1871. 

Meadows, Dr. Alfred. The Practitioner, September, 1868. 

Nicol, Dr. Patrick, and Isaac Mossor. On the Action of Certain Neurotics on the 
Cerebral Circulation. British and Foreign Medico- Cliirurgical Review, July, 1872. 

Schneider, Dr. Berliner klinische Wochenschrift, vi., 30, p. 390. 
£3 



338 EXCITO-MOTORS. 

Digitalis. — The leaves of digitalis purpurea, from plants of the 
second year's growth. Feuilles de digitate, Fr. ; Fingerhutblatter, 
Ger. 

Infusum Digitalis. — Infusion of digitalis ( 3 j — 1 v "j)- Dose, § ss 

— !j- 

Fxtractum Digitalis Fluidum. — Fluid extract of digitalis. Dose, 

m. j — iij. 

Fxtractum Digitalis. — Extract of digitalis. Dose, gr. ss — grs. ij. 

Tinctura Digitalis. — Tincture of digitalis. Dose, m. v — 3 j. 

Composition. — Digitalis contains an active principle, digitaline. 
This exists in the amorphous and crystalline form. The amorphous 
form — the digitaline of Homolle and Quevenne — possesses considerable 
activity, and, according to some authorities, is quite equal to the crys- 
talline in strength. The crystalline digitaline (Nativelle's digitaline), 
physiological investigations have shown, is really an active pi-inciple 
which represents all of the powers of the drug. This occurs in needle- 
shaped crystals, and has an extremely bitter taste. 

According to Schmiedeberg, digitalis contains digitonine, which 
strongly resembles saponine ; digitaline, which is insoluble in water, 
and is the chief constituent of Homolle and Quevenne's digitaline ; 
digitale'in, which is readily soluble and has the same action as German 
digitaline ; digitoxine, the most powerful, and is the principal constitu- 
ent in Nativelle's digitaline. Koppe has examined the action of digi- 
taline, digitaleiin, and digitoxine, and finds that they agree in their 
action, and with the crude drug, but differ in degree of activity. 

Digitalinum. — Digitaline. " A white, or yellowish-white powder, 
without odor, and having a very bitter taste." Dose -fa — fe of a grain. 

Antagonists and Incomtatibles. — The cinchona preparations, ace- 
tate of lead, the sulphate and tincture of the chloride of iron, are chemi- 
cally incompatible. Tannic acid and the preparations containing it 
diminish the physiological activity of digitalis. Ojnum, aconite, lobelia, 
and the cardiac paralyzers, antagonize some of the actions of digitalis, 
but the antagonism does not extend throughout the whole range of 
their influence. The most complete physiological antagonism exists 
between digitalis and saponine (Kohler), the active principle of sapo- 
naria officinalis, closely allied to senegine. Aconite antagonizes the 
cardiac action of digitalis, and morphia, also, to a less degree. 

Synergists. — Cold, ergot, belladonna, increase the physiological 
activity of digitalis. 

Physiological Action. — Digitalis has a disagreeable, bitter taste. 
In considerable doses, of the infusion, for example, it disturbs the stom- 
ach and gives rise to nausea and vomiting, and frequently purges. Loss 
of appetite results from its medicinal administration in some subjects, 
even when the quantity is small ; but, in others, the appetite is in- 
creased. The active constituents of digitalis diffuse into the blood, but 



DIGITALIS. 339 

nothing is definitely known us to the action of this agent on the com- 
position of the blood, or the influence which it has, if any, on the mor- 
phological elements. 

On the heart digitalis exerts a peculiar action which requires atten- 
tive examination : it prolongs the diastole and increases the vigor of 
the systole. A lethal dose arrests the heart in systole, inducing a tetan- 
ic state of the heart-muscle. While digitalis increases the power of 
the systole, the diastole is prolonged, hence the number of pulsations 
per minute is reduced. With ordinary medicinal doses this slowing of 
the heart may be considerable, and the pulsations may descend to fifty 
or even forty per minute. Microscopic examination of the mesentery 
(Ackermann) and of the web of the frog has definitely ascertained 
that a marked contraction of the arterioles takes place under the influ- 
ence of digitalis. The increased power of the systolic contraction of 
the heart and the greatly-increased resistance in front from a narrow- 
ing of the calibre of the vessels produce, as might a priori be ex- 
pected, a considerable rise of the blood-pressure. When the pulse is 
greatly reduced by the administration of large medicinal doses, a change 
from the recumbent to the upright posture causes a remarkable increase 
in the number, and diminution in the force, of the cardiac pulsations. 
When lethal doses, short of a sudden toxic effect, have been experi- 
mentally administered, the slowing of the heart and rise of arterial ten- 
sion first produced are succeeded by a quick, feeble pulse, and fall in 
the blood-pressure. These results are obviously due to the loss of 
poAver (paresis) which results from oyer-stimulation. 

A temporary rise of temperature follows the administration of a 
lethal dose of digitalis, but this rise is soon succeeded by a marked and 
sustained reduction. Owing to the increased resistance from diminu- 
tion of the calibre of the arterioles, the actual energy expended by the 
heart is in part converted into heat. Subsequently the slowing of the 
circulation, especially through the lungs (Traube), hinders the combus- 
tion process, and hence the fall of temperature. 

Digitalis in full medicinal doses produces headache, a band-like feel- 
ing around the forehead, dizziness, disturbances of vision (mistiness, 
vibratory movements of external objects, chromatic dispersion, etc.), 
drowsiness, languor, and a sense of weariness, and it may even cause 
hallucinations, illusions, and delirium. Digitalis lessens the reflex func- 
tion of the cord, lowers the sensibility of the nerves, motor and sensory, 
and impairs the electro-contractility of muscles ; but these effects are 
not produced by medicinal doses, but are toxic in character. 

As might be anticipated from a study of its physiological actions, 
digitalis acts like ergot on the enlarged uterus ; it stimulates to ener- 
getic contraction the muscular fibres, and in this way arrests uterine 
haemorrhage. On the genital organs of man it has a similar action ; by 
diminishing the blood-supply to the erectile tissue it lessens the power 



340 EXCITO-MOTORS. 

of erections, and, secondarily, affects the venereal appetite, producing 
anaphrodisia. 

Considerable difference of opinion exists as to the influence of digi- 
talis on the function of nutrition — the metamorphosis of tissue. By 
some an increase in the production of urea, by others, a diminution has 
been noted. The truth, most probably, is that it has no real influence 
in urea formation, and that the variations observed are accidental. The 
phosphoric acid and chlorides are diminished. In health digitalis affects 
but little the water of the urinary secretion ; according to some the 
water is diminished, according to others increased. It is difficult to 
reconcile these opposing statements, in view of the fact which has re- 
cently been ascertained by Brunton, that the diuretic action of digitalis 
in dropsy is not due to the increased blood-pressure, but to a special 
action on the Malpighian tufts. 

Therapy. — Before entering on the therapeutical applications of 
digitalis, there are several practical points with regard to the quality 
of the drug which require attention. Disappointment in the use of 
digitalis is frequently experienced, in consequence of the inferior qual- 
ity of the drug prescribed. The wild digitalis is better than the culti- 
vated. In this country much of the digitalis found in the shops is the 
plant cultivated and put up by the Shakers. It is very uncertain, and, 
according to the author's observation, usually inert. The English digi- 
talis, and the preparations made from it, should alone be prescribed. 

Digitalis has an undoubted power to arrest haemorrhage. The mech- 
anism of its action is similar to that of ergot ; it slows the action of the 
heart and contracts the arterioles. In haemoptysis it is especially useful 
in the following state of things : frequent expectorations of bloody 
mucus, with occasionally a mouthful of florid blood, accompanied by 
fever. This group of symptoms is dependent on transudation from a 
number of small vessels about the site of a pneumonia due to a tubercu- 
lar or caseous deposition. The same kind of expectoration, due to pul- 
monary congestion from mitral regurgitation, is amenable to the same 
treatment. In uterine haemorrhage digitalis is also serviceable, but it is 
more especially indicated in menorrhagia and metrorrhagia of plethoric 
subjects. Like ergot, digitalis has the power to induce uterine con- 
tractions, and hence it has been used successfully to arrest postpartum 
haemorrhage. Cases of menorrhagia, of a peculiarly obstinate kind, are 
caused by mitral regurgitation or stenosis, the mechanical result being 
to increase the blood-pressure in the venous system of the uterus. 
Digitalis is the appropriate remedy in such cases. Granules of digita- 
line may be prescribed for some days previously to the occurrence of 
the menstrual molimen, but during the attack the infusion of digitalis 
is more serviceable. In cases of haemorrhage, generally speaking, the 
infusion is the most effective form in which to employ digitalis. If the 
symptoms are urgent, a tablespoonful of the infusion may be given 



DIGITALIS. ;; 1 1 

every half-hour until four doses are taken. In ordinary cases a table- 
spoonful of the infusion twice a day is a sufficient quantity to maintain 
a constant physiological effect. In the treatment of haemorrhage, digi- 
talis may be combined with other remedies which are synergistic. IjL 
Infus. digitalis, 3 ij ; tinct. kramerije, ext. ergotse fluidi, aa 3 j. M. 
Sig. A tablespoonful pro re nata. 

In purpura and the hemorrhagic diathesis, digitalis is useful when 
given conjointly with restorative medicines ; but, as a dyscrasia exists on 
which the extravasations of blood depend, it is obviously necessary to 
correct this state of things, in order that the patient shall be benefited 
by a remedy which gives tone to the heart and vascular system. 

The most important uses of digitalis are in cardiac diseases. In 
general terms it may be said that it is indicated when the action of the 
heart is rapid and weak and the arterial tension low, and is contrain- 
dicated tchen the action of the heart is v igorous and the arterial tension 
high. 

In simple hypertrophy, which is compensatory, digitalis has no util- 
ity. In stenosis of the aortic orifice, with compensatory hypertrophy, 
it is not only useless, but it may give rise to serious symptoms, and 
even cause a fatal result, if administered in doses sufficient to produce 
physiological effects. When stenosis of the aortic orifice leads to in- 
competence and regurgitation of the mitral, then digitalis may be used 
with advantage. As respects the nature of the cardiac lesion merely, 
digitalis is useful in dilated heart with incompetence of the mitral, in 
disease of the mitral orifice with stenosis or regurgitation, and in dilata- 
tion of the right heart with incompetence of the tricuspid. As respects 
the mechanical difficulties which ensue from cardiac lesions merely, 
digitalis is useful, by reason of the increased power which it gives the 
auricles and ventricles to empty their respective cavities, and the longer 
intervals between the pulsations, which enable the auricles more per- 
fectly to discharge their contents into the ventricles. The mechanical 
difficulty consists in a deficiency of blood {ischemia) on the arterial 
side, and a stasis of blood on the venous side, of the systemic and pul- 
monary circulation. Digitalis, therefore, assists in the " compensation," 
or, in other words, by its action on the heart restores the mechanical 
balance of the circulation, deranged by the cardiac lesions. As respects 
the rational symptoms of heart-disease, digitalis is useful when the 
action of the heart is rapid and weak, the tension of the pulse low, when 
there are cough, difficulty of breathing, a dusky countenance, pulsating 
jugulars, scanty and high-colored urine, and general dropsy. As a rule, 
it may be stated that the rational signs furnish more conclusive indica- 
tions of the need of digitalis than the physical. If given in suitable 
cases, the action of digitalis in heart-diseases is most conspicuous for 
good ; but careful consideration should be given to the conditions de- 
tailed above if the practitioner would procure thoroughly satisfactory 



342 EXCITO-MOTORS. 

results. The form in which digitalis is prescribed is most important. 
The infusion is the best form in cases of cardiac disease with dropsy. 
It should be given in tablespoonful doses, twice a day, until some char- 
acteristic physiological effects are produced. After the subsidence of 
the severe symptoms digitaline-granules may be substituted for the in- 
fusion, or the powder of the leaves may be given in pill-form. As very 
decided anaemia is present in these cases, the best results are obtained 
by a combination of digitalis with quinia and iron. IJ. . Pulv. digitalis, 
3ij; ferri redacti, quiniae sulph., aa 3j. M. ft. pil. no. xx. Sig. One 
pill two or three times a day. 

The antipyretic effect of digitalis is a fact much insisted on in Ger- 
many (Traube, Wunderlich, Thomas, Liebermeister, etc.). In the re- 
oent elaborate work of Husemann digitalis is classed with the Fie- 
bermittel — the " antipyretica." The results which have followed its 
administration as an antipyretic in fevers (typhoid, typhus, etc.), do 
not, it appears to the author, justify its use in these maladies, notwith- 
standing its power to lower the temperature. The indications for its 
use are, according to Liebermeister, just the opposite of those which 
obtain in cardiac disease; that is, "digitalis is only to be used in those 
cases of typhoid fever in which there is no considerable degree of car- 
diac weakness." He usually gives from eleven to twenty-two grains, 
extended over a period of about thirty-six hours. 

In scarlet fever the utility of digitalis is very great ; it lowers the 
temperature and maintains the action of the kidneys, thus obviating the 
two principal sources of danger in that disease. A drop or two of the 
tincture given every hour or two, according to the age, in a little water, 
or from half a teaspoonful to a teaspoonful of the infusion every two, 
three, or four hours, is a suitable mode of administration. If uraemia 
occur, the infusion is the proper remedy, conjoined, of course, with other 
means. The author has seen most excellent results from a poultice of 
digitalis-leaves, applied to the abdomen and back, in cases of uremic 
convulsions, the patient being unable to swallow, or the stomach so 
irritable as to reject all medicines. 

Digitalis has been used with success in erysipelas, but it is by no 
means equal to belladonna in this affection. 

In rheumatic fever the testimony in favor of the use of digitalis is 
certainly very strong. It lowers the temperature, and apparently ma- 
terially shortens the duration of the disease. It may be given in pow- 
ders — two grains every four hours — or a corresponding quantity of the 
infusion. In rheumatism, as in every other affection, very prompt effects 
do not follow the use of digitalis ; a day or two must elapse before any 
marked reduction of temperature takes place, but a cessation of the 
joint-trouble may be looked for in seven to ten days. Digitalis is more 
particularly useful in the cardiac complications of acute rheumatism, 
when irregular and feeble action of the heart, difficult breathing, cya- 



DIGITALIS. 843 

nosis, and general oedema, are present. The following is a prescription 
of Oppolzer in this condition: I£. Inf. digitalis, 3 ij ; liq. potassii 
citrat., sjss; acet. scillrc, 3 ss. M. Sig. A tablespoon fid every four 
hours. 

Digitalis has recently been much employed in inflammatory affec- 
tions, notably pneumonvi. On examination of the reported cases the 
author finds that the defervescence, produced apparently by digitalis 
from the sixth to the tenth day, occurred at the time when the crisis in 
pneumonia is to be expected, and hence it is difficult, if not impossible, 
to estimate the precise share which the remedy had in the results. That 
digitalis has any power to prevent the deposition of fibrinous material, 
to prevent or check the migration of the white corpuscles, or to arrest 
the multiplication of the cellular elements of inflamed parts, seems to 
the author highly improbable. That it may be useful to combat some 
of the symptoms — high temperature, ischsemia of the arterial system 
from pulmonary obstruction, and low tension of the vessels — may be 
well admitted. 

There is considerable evidence to show that digitalis is serviceable 
in chronic bronchitis with interstitial pneumonia (fibroid lung), -when 
accompanied with difficult breathing, secondary dilatation of the right 
cavities, and general anasarca. It diminishes the cough and expec- 
toration, tones up the weakened and laboring heart, and reduces the 
oedema. That digitalis has any curative power in pxdmonary tubercu- 
losis or caseous pneumonia, can hardly be credited, notwithstanding 
the claims which have been put forward. It may be used as an anti- 
pyretic when there is much hectic, but the derangement of the intes- 
tinal canal produced by it is a most serious bar to its employment in 
phthisis. 

Some important results have been obtained by the use of digitalis 
in nervous diseases. The congestive form of hemicrania may not un- 
frequently be permanently relieved by the persistent use of digitaline- 
granules (one-sixtieth of a grain bis die). Acute maniacal delirium, 
chronic mania, and delirium tremens, are disorders of the brain in 
which digitalis has proved very useful. The conclusions of Dr. Wil- 
liams, of Hay ward's Heath Asylum, are as follows : 

" 1. That digitalis is a valuable sedative in the treatment alike of 
recent and chronic mania, and when these forms of disease are compli- 
cated with general paresis and with epilepsy. 

" 2. That the average dose of the tincture is from 3 ss to 3 j, and 
this quantity may be certainly given with impunity for several days, 
and subsequently — adjusted to the state of the pulse — may be advan- 
tageously used for several months. 

" 3. That the indication by which the use of this drug is regulated 
is the state of the pulse, any marked intermittence requiring its imme- 
diate discontinuance. 



344 EXCITO-MOTORS. 

" 4. That the weakness of the circulation is no indication against its 
employment ; on the contrary, experience shows that the most enfeebled 
subjects bear its administration as well as the most robust." 

In delirium tremens extraordinary doses of the tincture of digitalis 
have been used with success ( 3 ij — 3 iv), but these large doses are un- 
necessary. This treatment is most useful in the young and robust, with 
marked cerebral hyperemia, according to some; but, according to others, 
in pale subjects with a tendency to cyanosis, the state of the brain being 
one of anaemia, with effusion and oedema. According to the author's 
observation, the latter indications are the more correct. The infusion 
is doubtless a better preparation than the tincture, and of this a table- 
spoonful may be administered every four hours. 

Some supposed cases of arachnitis have been reported cured by 
digitalis, but grave doubts must exist as to the accuracy of the diag- 
nosis. 

Cases of exophthalmic goitre in young subjects, purely functional in 
character, have been cured by digitalis, and the cardiac irregularities, 
and the dilatation of the cervical vessels, ameliorated in even incurable 
cases. Digitaline is the form in which to employ this remedy, or pow- 
dered digitalis may be given in pill, with iron and manganese to remove 
the anaemia. 

Since the anaphrodisiac properties of digitalis were ascertained, it 
has been much used in spermatorrhoea. It is adapted to the same class 
of cases as those in which ergot has been shown to be so beneficial, viz., 
feeble erections, frequent emissions, and cold hands and feet. The au- 
thor has seen better results from the combination of bromide of potas- 
sium and digitalis, in the spermatorrhoea of plethora, than from any 
other remedies : $ . Inf. digitalis, § viij ; potassii bromidi, § j. M. 
Sig. A tablespoonful morning and night, and, after a week, at night 
only. 

Digitalis is one of the most generally useful remedies in dropsy 
which we possess. It is, of course, specially useful in the mechanical 
dropsy of valvular lesions. In renal dropsy from acute desquamative 
nephritis (tubal nephritis) " of all drugs, digitalis is of the greatest 
value," and the best form in which to administer it is the infusion. 
Several days usually elapse before very decisive results are achieved, 
but the flow of urine is, then, often enormous. The fact that, contrary 
to what has been heretofore believed, digitalis has a direct action on 
the glomerule of the kidney, is of great interest in this connection. 
The author has seen very favorable results from the use of digitalis in 
granular degeneration of the kidney when dropsy supervened, but its 
use in this disease requires caution in consequence of the fact that the 
elimination of urea and of the chlorides is retarded by this agent. 

The so-called Cumulative Effects of Digitalis. — The author agrees in 
opinion with those who hold that digitalis is not a cumulative poison in 



DIGITALIS. 345 

the sense in which this term was formerly used. Doses of digitalis fre- 
quently repeated, so that the effect of one is added to those before 
given, will certainly produce toxic symptoms. In this sense opium, 
belladonna, strychnia, etc., are cumulative poisons. If full doses of digi- 
talis are given at proper intervals, and the effects of one dose are per- 
mitted to cease before the next is given, no accumulation will take place. 
Sudden toxic symptoms are developed as follows : "When, after the ad- 
ministration of large doses, the pulse is much reduced in the recumbent 
posture; on rising, the heart is suddenly found unequal to maintaining 
the circulation in face of the increased resistance in the arterioles and 
against the force of gravitj-. It must not be forgotten, further, that the 
irritability of the vaso-motor nervous system may be destroyed by over- 
stimulation by digitalis, and lethal effects be produced in this way. 

Authorities referred to : 

Ackermann, Prof. Th. Ueber die Wirkungen der Digitalis. Volkmanii's Sammlung, 
No. 48. 

Boeiim, Dr. Rcdolph. Ueber die physiologische Wirkung der Digitalis und des Digi- 
talin. Schmidt's Jahrbiicher, vol. cliii., 1872. 

Briesemanx, Dr. C. Schmidt's Jahrbuclier, vol. cliii., p. 29. 

Dybkowsky, W., ond Pelikatj, Eug. Schmidt's Jahrbiicher, vol. exvi., p. 170. 

Foster, Dr. B. Clinical Medicine: Lectures and Essays, 1874, p. 92. Digitalis in 
Heart Disease. 

Fothergill, Dr. J. Milner. Prize Essay. British Medical Journal, July and August, 
1871. 

Gourvat, M. Gazette dc Paris, July to December, 1871, and January to February, 
1872. 

Hirtz, Dr. Gazette Medicale de Strasbourg, 1862. 

Holland, Sir Hen~ry. Medical Notes and Reflections, American edition. 

IIomolle, M. Archives Generales, July, 1861, p. 5. 

Husemann, Prof. Dr. Tii. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 914, el seg. 

KOiiler, Dr. H. Ueber den Antagonismus der physiologischen Wirkungen der Saponin 
tind Digilalin, . Archiv f. exper. Path, vnd Phar., 1873, p. 138. 

Ibid. Handbuch, p. 174. 

Liebermeister, Prof. Dr. Kat.l. Ziemssen's Cyclopaedia of the Practice of Medicine, 
rol. i., p. 217. 

Matjdsley, Dk. Henry. The Practitioner, January, 1869. 

Schmiedeberg, Prof. Archiv fur exper. Pathol, und Pharmacol. Band iii., p. 16. 

Taylor, Dr. A. S. On Poisons, third edition, London, p. 796. 

Traube, Prof. Dr. L. Berliner klinische Wochcnschriff, No. 17, April, 1870, and No. 
18, May 2, 1870. 

Weil, Dr. A. Schmidt's Jahrbiicher, vol. cliv., p. 143. 

Wood, Dr. H. C. Therapeutics, Materia Medica, and Toxicology. 

Cimicifuga. — Black snake-root. The root of cimicifuga racemosa. 

Extractum Cimicifuga, Fluidum. — Fluid extract of cimicifuga. 
Dose, 3 ss — 3 ij. 

Tinctura Cimicifugce. — Tincture of cimicifuga (unofficinal). Dose, 
3 ss— 3 ij. 



346 EXCITO-MOTORS. 

Composition. — When fresh, the root contains a volatile oil, which 
possesses in a high degree the characteristic odor of the drug. A true 
active principle has not yet been isolated, yet Conard has obtained a 
neutral substance, crystallizable, and having a very acrid taste. The 
so-called cimicifugine is nothing more than an impure resin, obtained 
by precipitation from the tincture by the addition of water. The root 
contains resin, coloring matters, tannic and gallic acids. 

Antagonists and Incompatibles. — As the preparations of cimicifu- 
ga contain tannic and gallic acids, they are incompatible with the salts 
of iron. Stimulants, as alcohol, ammonia, antagonize cimicifuga thera- 
peutically. 

Synergists. — In its action, although feeble, cimicifuga lies between 
digitalis and ergot. Its physiological effects are increased by cold, digi- 
talis, ergot, belladonna, etc. 

Physiological Actions. — The taste of cimicifuga is bitter and as- 
tringent, with an after acrid feeling. In small doses, without producing 
any sensible physiological effect, it promotes the appetite and digestion. 
In full doses it increases the gastro-intestinal secretions. On the heart 
and circulatory system, cimicifuga has an action not unlike digitalis, but 
less powerful : it slows the heart-beats but increases their force, and 
elevates the tension of the arterial system. Its effects on the nervous 
system, when administered in large doses, are very decided. It causes 
vertigo, dilated pupils, and in many subjects considerable soporific and 
anodyne effects. There is little doubt that it increases the contractility 
of unstriped muscular fibre in a manner that resembles ergot, but much 
less energetically. It stimulates the venereal appetite in man, and pro- 
motes the menstrual flow in women. Diaphoresis and increased bron- 
chial secretion are produced by it, and the urine possesses a distinct 
odor of the drug. 

In order to procure physiological effects from cimicifuga, it is essen- 
tial that preparations made from the fresh root be employed. 

Therapy. — Cimicifuga is an excellent stomachic tonic, and is espe- 
cially adapted to the treatment of the irritative dyspepsia of drunk- 
ards. In fevers and inflammatory disorders, when the action of the 
heart is quick and the tension of the vessels low, cimicifuga may take 
the place of digitalis, but it is much less efficient than the latter. It is 
an excellent expectorant, useful in bronchitis and in neuropathic pulmo- 
nary disorders. IjL Ext. cimicifugae fl., fss; tinct. opii deod., 3 ij ; 
syrp. tolu., 3 x. M. Sig. A teaspoonful every four hours. This com- 
bination is efficacious in acute catarrh (common cold), and in acute 
bronchitis after the more active symptoms have subsided. Good re- 
sults have been . obtained from cimicifuga in phthisis. It would be 
idle to claim that it is curative ; but, to moderate hectic, to improve 
the appetite, and to facilitate expectoration, it is undeniably of ser- 
vice. It is in that form of phthisis now called caseous pneumonia 



CIMICIFDGA. 347 

that cimicifuga can be expected to relieve symptoms, and not in tuber- 
culosis. 

Dilated heart, fatty heart, languid circulation, oppressed breathing, 
general dropsy, are conditions in which cimicifuga takes the rble of digi- 
talis, and sometimes more efficiently. It is safer than digitalis, espe- 
cially in the case of fatty heart. 

Most favorable reports have been made of cimicifuga in acute rheu- 
matism. Chronic rheumatism, with tumefaction of the joints, lumbago, 
intercostal pain, and myalgia, are disorders affecting the muscular sys- 
tem, in which this drug sometimes succeeds in a wonderful manner; 
yet it very often fails, and we are, unfortunately, unable to indicate be- 
forehand the particular kind of cases in which it is most beneficial. 

The power of cimicifuga to relieve certain kinds of pain is well 
established. Neuralgia of the fifth, arising from cold, rheumatic head- 
ache, ovarian neuralgia, succeeding to suppressed or arrested menstru- 
ation, etc., are forms of pain in which this remedy is frequently very 
effective. 

Puerperal mania, hypochondriasis, and convulsions, due to men- 
strual irregularities, have been cured by cimicifuga. The greatest suc- 
cesses of this drug have been achieved in chorea. It is useful in those 
cases which arise about the period of puberty, and are connected with 
disorder's or perversions of the menstrual flow. 

Cimicifuga relieves the pains of dysmenorrhea when of the con- 
gestive variety. Heat of head, flushings of the face, pain in the head, 
back, and limbs, quick pidse, and nervousness, when due to arrest of 
the monthly flow, are often remarkablj' benefited by this agent. It has 
been used to promote parturient pains, to induce uterine contractions 
after delivery, and to relieve after-pains, but it is inferior to ergot for 
most of these purposes. It is serviceable in subinvolution of the uterus, 
and may be given in combination with ergot. 

The aphrodisiac effects of cimicifuga render it useful in spermator- 
rhoea. It is not adapted to physiological spermatorrhoea, which is really 
a condition of normal plethora, but to those cases in which the organs 
are relaxed, the erections weak, and the seminal discharges feeble and 
occur on slight excitement. 

To obtain curative effects from cimicifuga, it must be administered 
in sufficiently large doses to produce some of its cerebral effects. 

Authorities referred to : 

Davis, Dr. N. S. Transactions of Ike American Medical Association, i., 352. 

Hildreth, Dr. American Journal of Medical Sciences, October, 1842. 

Phillips, Dr. Charles D. F. Materia Medica and Therapeutics, London, 1874, p. 89 

PoRcnER, Dr. Francis P. Resources of the Southern Fields and Forests, p. 18. 

Ringer, Dr. Sydney. Handbook of Therapeutics, article Actcea. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, vol. ii., p. 562. 

United States Dispensatory, thirteenth edition. 



348 EXCITO-MOTORS. 

Belladonna. — Deadly nightshade. 

Bellocdonnce Folice. — Belladonna-leaves. Feuilles de bettadone, Fr. ; 
Tollkraut, Ger. 

JSelladonnce Radix. — Belladonna-root. Racine de belladone, Fr. ; 
Belladonnaiourzel, Ger. 

JEmplastrum Belladonnoe. — Belladonna-plaster. (Belladonna-root 
and resin-plaster.) 

Fxtractum Belladonnas. — Extract of belladonna. Dose, gr. £ — gr. j. 

Extractum Belladonnas, Alcoholicum. — Alcoholic extract of bella- 
donna. Dose, gr. \ — gr. j. 

JExtractum Belladonnoe Fluidum. — Fluid extract of belladonna. 
Dose, m. j — m. v. 

Suppositoria Belladonnoe. Suppositories of belladonna. (Alcoholic 
extract and cacao-butter. Each suppository contains thirty grains — 
gr. ss — grs. xxixss.) 

Tinctura Belladonnoe. — Tincture of belladonna. Dose, m. v — 3 ss. 

TTnguentum Belladonnoe. — Ointment of belladonna. (Extract, 3 j ; 
lard, 3 vij.) 

Composition. — Belladonna contains a peculiar alkaloid atropia, on 
the presence of which the physiological activity of the drug depends. 
This principle is found chiefly in the bark of the root, and of young root. 
Another principle has also been discovered analogous to atropia, to 
which the name belladonnine has been given. The root also contains 
a fluorescent substance and a coloring matter, which has been called 
atrosin. Atropia exists in the plant in combination with malic acid as 
bimalate. 

Atropia. — Atropia. " Is in yellowish-white, silky, prismatic crystals, 
without smell, but having a bitter and acrid taste. It is soluble in three 
hundred parts of water at 60° Fahr., in twenty-five parts of ether, and 
in much less alcohol. It has a strong alkaline reaction, and forms crys- 
tallizable salts with acids." 

Atropice Sulphas. — Sulphate of atropia. " Is a white, slightly crys- 
talline powder, very soluble in water and in alcohol, insoluble in ether, 
and wholly dissipated by heat." Dose, gr. -j-J^- — gr. -gL. 

Antagonists and Incompatible s. — Caustic alkalies act on atropia, 
and ammonia is evolved; they are, therefore, incompatible with the 
preparations of belladonna. As respects physiological antagonism, 
physostigma counterbalances the actions of belladonna in almost the 
whole range of its influence. Opium — within certain limitations to be 
hereinafter described — antagonizes the actions of belladonna. In cases 
of poisoning, the stomach should be promptly emptied by emetics (sul- 
phates of zinc or copper), and the nervous disturbances combated, as 
they arise, by physostigma or opium ; also, by pilocarpus. 

Physiological Actions. — Dryness of the mucous membrane of the 



BELLADONNA. ;;i!) 

nose, mouth, throat, and larynx, is produced by the direct application 
of atropia to these parts, and the same effects in a more positive man- 
ner follow the stomach or subcutaneous administration. A peculiar 
bluish appearance of the lips, as well as dryness, the author has fre- 
quently observed. Nausea is occasionally produced by belladonna, but 
this effect is probably due to cerebral disturbance. Dryness of the mu- 
cous membrane of the stomach and intestines is doubtless produced by 
belladonna, but increased secretion occurs subsequently, for the stools 
are rendered more liquid, and are also voided more frequently. In- 
creased peristalsis is most probably a result of the action of belladonna 
on the unstriped muscular fibre of the intestines. 

The active principle of belladonna (atropia) is an extremely diffus- 
ible substance. What changes it induces in the blood, if any, are not 
known. It affects the circulation in a remarkable manner. In some 
subjects a decided slowing of the heart takes place immediately after 
the administration of a considerable dose (atropia hypodermically), and 
in all, most probably, an instantaneous retardation of the pulse-rate, but 
a very decided rise in the number of pulsations quickly follows. Not 
only is the number of the heart-beats increased, but their vigor also, 
and the area over which the pulsations are distributed is enlarged. It 
has been conclusively shown that the increased action of the heart is 
due, first, to stimulation of the cardiac ganglia of the sympathetic, and, 
secondly, to a paralyzing action on the pneumogastric terminal fila- 
ments. In other words, the motor power of the heart is increased in 
activity, and the inhibiting control is lessened. 

The stimulation of the vaso-motor centres by belladonna, or atropia, 
is not confined to the cardiac ganglia, but extends to the vaso-motor 
ganglia throughout the body, and a general rise of blood-pressure takes 
place owing to a contraction of the arterioles. It is a singular fact that 
the influence of atropia rapidly produces a state of over-excitation, and 
the irritability of the vaso-motor nervous system, at first increased, soon 
diminishes ; the action of the heart becomes weak, the vessels dilate, 
and the blood-pressure falls below the normal. In large medicinal doses 
this effect is easily seen, and, in lethal doses in animals, it may be most 
certainly demonstrated. 

As regards the function of respiration, atropia increases the number 
and depth of the respiratory movements, but the increase is not in the 
same ratio as is the elevation of the pulse-beat. The more rapid action 
of the heart, the increased respiratory movements, the contraction of 
the arterioles, result in an increased supply of blood to the periphery, 
more rapid nutritive changes, and consequent elevation of temperature. 
The rise in temperature in man, from a full medicinal dose, is from i° 
to 1° Fahr. This increased body -heat is not long maintained ; with the 
fall in the blood-pressure (vaso-motor paresis), there ensues a diminu- 
tion in temperature. 



350 EXCITO-MOTORS. 

In persons of a light complexion, more especially in women, a full 
dose of atropia is frequently followed by a diffused redness of the skin, 
not unlike the rash of scarlatina, but wanting in the punctated char- 
acter of this specific eruption. Redness of the fauces, and some diffi- 
culty of swallowing, owing to the dryness of the mucous membrane, 
occur at the same time, rendering the similitude to scarlet fever very 
striking. The flush of atropia succeeds to a marked but temporary 
pallor, which is the first effect, and is a symptom of the vaso-motor 
paresis which succeeds to the vaso-motor stimulation. The belladonna 
rash is sometimes followed by desquamation. 

Dilatation of the pupil is a conspicuous effect of atropia. Whether 
dropped into the eye, introduced into the stomach, or injected under 
the skin, prompt and decided dilatation of the pupil follows. A much 
smaller quantity suffices to produce this effect, when applied directly to 
the eye. Paresis of the muscle of accommodation is caused by atropia, 
and this agent also lessens the intraocular pressure. It has been con- 
clusively shown that atropia produces these remarkable effects by an 
action on the peripheral filaments of the nerves of the iris, and not on 
its muscular fibres : atropia paralyzes the oculo-motor nerve end-organs, 
and stimulates those of the sympathetic. 

The cerebral effects of belladonna are very characteristic. Head- 
ache, vertigo, illusions, hallucinations, a busy delirium, sometimes som- 
nolence, are produced by large doses. The vision is usually lost, the 
pupils are dilated to the utmost, the eyes are brilliant and staring. 
Muscular weakness, incoordination, and complete motor paralysis occur ; 
but sensation is not destroyed ; although occupied with fancies and 
illusions, the patient may be indifferent to moderate irritation. The 
delirium which occurs has a peculiar character ; it may be gay and 
laughing, or busy, the patient being incessantly occupied with a single 
object or idea, or it may be noisy and furious, the patient fighting and 
striking all who approach. In lethal doses convulsions may occur, or 
profound stupor may result after a period of delirious excitement. 

The voluntary muscles are not affected by belladonna. The museu 
lar paresis which results from the administration of this drug is due to 
its action on the motor nerves, but the excitability of these nerves is 
diminished only, and not wholly destroyed. Both the motor-nerve trunks 
and the end-organs are affected. The sensibility of the sensory nerves 
is also impaired, but is not diminished to the same extent as is that 
of the motor nerves. 

Although the action of belladonna is so largely paralyzant, it is not 
exclusively so, and, under certain circumstances, a tetanic action very 
similar to that caused by strychnia is developed. In frogs, a day or 
two after the induction of paralysis by the subcutaneous injection of 
atropia, the tetanic state occurs. When this state is reached,, although 
the frog lies perfectly limp and motionless if undisturbed, an irritation 



BELLADONNA. ,'55 1 

applied to the periphery will at once cause general tetanic rigidity and 
spasms. The author was the first to show that this condition of the 
nervous system is attained in frogs an hour or two after the conjoined 
administration of atropia and physostigmia {eserinc). 

Atropia, by virtue of the greater than normal transmission of blood 
through the tissues, increases metamorphosis, and tlie results of this are 
represented in an increased elimination of the products of waste. 

Atropia is eliminated chiefly by the urine, and the urine of an atro- 
pinized animal will dilate the pupil of another animal. 

Therapy. — In mercurial ptyalism, and the ptyalism of the pregnant 
state, a few drops (five to ten) of the tincture of belladonna, given every 
four to six hours, or a corresponding quantity of atropia, will cause the 
excessive secretion to diminish, and even dry up, and will thus relieve a 
very disagreeable symptom. Gastralgia, as well as the pain which 
accompanies gastric ulcer, is often happily relieved by atropia. 1J. 
Atropiae sulphatis, gr. j ; zinci sulphatis, 3 ss; aquas destil., 3 j. M. Sig. 
From three to five drops twice or thrice a day. A similar combination 
is very effective in pyrosis, chronic gastric catarrh, and irritative dys- 
pepsia. Atropia is frequently effective in relieving the vomiting of 
pregnancy. R,. Atropias sulphat., gr. ij ; aquae destil., § j. M. Sig. 
Two drops in water before meals. It is often more useful when applied 
to the rectum in the form of suppository. It sometimes gives great re- 
lief when applied to the epigastrium in chloroformic solution. ]$. 
Atropia?, gr. v ; chloroformi, § j. M. Sig. A piece of lint to be moist- 
ened with the solution and laid on the epigastrium. 

The extract of belladonna is a useful addition to purgatives, to di- 
minish the harshness and at the same time to increase the effectiveness 
of their operation. Belladonna has the power to increase the peristaltic 
movements and to allay irregular or spasmodic movements. It is, there- 
fore, used to overcome habitual constipation. A pill containing a half- 
grain of extract, taken at night, will sometimes succeed, but it is gen- 
erally better to combine it as follows : IJ. Ext. belladonnas, ext. nucis 
vomicae, ext. physostigmatis, aa gr. iij. M. ft. pil. no. vj. Sig. One 
at bed-hour. An addition of a half-grain of aloine will, of course, in- 
crease the action of this pill, and may be added when there are great 
torpor and inaction of the intestines. 

When, in affections of the gastro-intestinal apparatus, acids are indi- 
cated with atropia, they may be combined as follows : I£ . Acid, muriat. 
dil., § j ; atropiae, gr. ss. M. Sig. Five drops in water before meals. 
Such a prescription is useful in heart-burn, water-brash, etc. 

Harley advises the use of atropia as a cardiac stimulant / but the 
fact that thi3 agent exhausts the irritability of the cardiac ganglia after 
a period of stimulation, seems to the author to contraindicate its use. 
Notwithstanding this objection, atropia may be given to counteract a 
sudden and temporary depression in the heart's action — as, for example. 



352 EXCITO-MOTORS. 

in the collapse of cholera, in which it has been employed successfully 
by the hypodermatic method. 

Belladonna is a remedy of great efficacy in certain acute inflamma- 
tions of the air-passages. No remedy gives such prompt and sustained 
relief in acute nasal catarrh with profase watery secretion. To adults, 
the best method of administration consists in giving a first dose of five 
drops of the tincture, and repeating a drop or two drops every hour 
until atropinism is produced. This remedy is also very admirably 
adapted to the treatment of ordinary sore-throat. As a constant phys- 
iological action of belladonna is redness and dryness of the fauces, its 
therapeutical action, in sore-throat with increased secretion, is antipathic 
or substitutive ; or, as it may be more scientifically expressed, the action 
of belladonna is the physiological antagonist of the disease-action. 
When there is much fever it is useful to combine aconite with bella- 
donna. 3. Tinct. aconiti rad., 3j; tinct. belladonna, 3 ij. M. Sig. 
Four drops in water every hour or two. That form of aphonia which 
is due to fatigue of the vocal cords may be removed very speedily by 
a morning and evening dose (y|-g — -fa of a grain) of atropia. Not un- 
frequently hysterical aphonia may be quickly cured in the same way. 

There is much to be expected from the use of belladonna prepara- 
tions in whooping-cough. The best form for administration is a solu- 
tion of the sulphate of atropia (gr. j — § j of water. Dose, m. ij — m. iv). 
This remedy is not adapted to all cases, and is most effective in the 
spasmodic stage. In order to be curative, physiological effects must be 
produced. The good results of atropia in whooping-cough are most ob- 
vious in those cases characterized by profuse bronchial secretion. 

Belladonna gives great relief in paroxysms of asthma, and in the 
spasmodic difficulty of breathing which accompanies emphysema. Ac- 
cording to the author's observation, when the bronchial mucous mem- 
brane is deficient in secretion, the pulse much accelerated, the skin dry 
and hot, belladonna rather adds to the distress ; and its good effects are 
most conspicuous when there are abundant expectoration, a cool and 
moist skin, and a quiet pulse of low tension. In asthma, atropia may 
be injected subcutaneously, or the belladonna-leaves be used by the 
method of fumigation. Belladonna-leaves, dipped in a saturated solu- 
tion of nitre and then dried, may be burned in a close apartment, the 
patient breathing the fumes until relief is obtained. Pastiles are made 
of belladonna, stramonium, poppy, tobacco, etc. A good formula for 
cigarettes is the following (Trousseau): Belladonna, grs. v; stramo- 
nium and hyoscyamus, of each grs. iij ; extract of opium, 4- of a grain ; 
cherry-laurel water, a sufficient quantity. The leaves are moistened with 
a solution of the opium in the cherry-laurel water, and when dry made 
into a cigarette. Two to four of such cigarettes may be smoked daily. 
When the paroxysms of asthma occur in the morning, they may some- 
times be prevented by the one-sixtieth of a grain of atropia at bedtime. 



BELLADONNA. ;;;,;; 

The remarkable similarity in the symptoms of atropinism and of scar- 
latina has led to the use, by homoeopathic practitioners, of belladonna 
is a prophylactic against this disease. The points of resemblance are 
so superficial, and the differences so wide, that no more striking instance 
could be adduced of the uncertainty in the application of the homoeo- 
pathic dogma, even admitting its truth. The author is convinced that 
the so-called prophylactic power of belladonna against scarlatina has 
no real existence. He has seen too many cases of scarlatina occur in 
subjects who had been given the remedy freely, to permit him to come 
to any other conclusion. Belladonna is a useful remedy to relieve some 
of the symptoms in scarlatina. During the stage of eruption it is indi- 
cated when the pulse is feeble, the bodily powers are depressed, and 
the rash is imperfectly evolved. In this condition of things — in which 
carbonate of ammonia is so much used — belladonna also renders most 
important service, but it should not be forgotten that these agents 
are chemically incompatible, and should not therefore be prescribed 
together. 

In diphtheria, when there is much depression, belladonna is a most 
excellent remedy. If given before the exiulation has spread and con- 
solidated into membranous plaques, and when a few patches only have 
appeared on the tonsils, or soft-palate, it seems to have the power to 
hinder the formation of the exudation. 

There is no doubt that belladonna has a real curative power in 
erysipelas. It is especially adapted to idiopathic erysipelas, notably 
to facial erysipelas, and is less serviceable in traumatic erysipelas. 
Homceopathists explain this on the doctrine of similars, but the action 
is really one of antagonism, or substitution. When there is much 
fever, digitalis or aconite may be combined with belladonna with ad- 
vantage, and when there is much depression, quinia. R. Quinias 
sulph., 3 ss ; belladonnas extract., grs. iij. M. ft. pil. no. x. Sig. One 
every four or six hours. 

Excellent results have been obtained from the use of belladonna in 
typhus and typhoid fevers. Graves originally suggested an indication 
for its use in fevers, which is doubtless serviceable, viz., contracted 
pupils ; but belladonna has been used, irrespective of this sign, by 
other practitioners with great success. The tincture is a suitable prepa- 
ration, and of this from five to ten drops every four hours is a proper 
dose. ' According to the author's observation, belladonna is indicated 
when there is much low, muttering delirium, subsultus, and stupor, and 
is contraindicated in the condition of delirium ferox. 

Belladonna has important application in the treatment of certain 
disorders of the nervous system. iSidc-headache, due to or accompanied 
by spasm of the arterioles — a condition manifested by pallor of the 
face, vertigo, and tinnitus aurium — is relieved by belladonna. At first 
the distress may be even increased, but great relief presently follows 
24 



354 EXCITO-MOTORS. 

This remedy is injurious in the congestive form of sick-headache. The 
following is a serviceable combination in the cases of sick-headache due 
to vaso-motor spasm: fy. Atropiae sulph., gr. ss; chinoidin, 3 j. M. 
ft. pil. no. lx. Sig. One pill twice or thrice a day. 

Although oelladonna in the physiological state induces wakeful- 
ness and busy delirium, in certain morbid states of the brain it is hyp- 
notic. The indications for its use are as follows : prostration, low 
state of the arterial tension, languid intra-cranial .circulation, a con- 
tracted pupil, and insomnia, due to the condition of the brain manifested 
by these objective signs. In various kinds of mental disorder, in which 
the foregoing symptoms are present, much good may be expected from 
the use of belladonna in moderate doses ; but harm only will be pro- 
duced by it when there is much vascular excitement. 

Belladonna, according to Trousseau and Pidoux, is a more efficient 
remedy in the treatment of epilepsy than the salts of silver, copper, or 
zinc. They insist that the capital condition of success is perseverance 
on the part of the physician and patient, that belladonna should be 
given steadily for a year in gradually-increasing doses, and that if 
amendment is then produced it should be continued through two, three, 
or even four years. Belladonna is not equal to bromide of potassium 
in cases of diurnal epilepsy, in epilepsy accompanied by cerebral hy- 
peremia, and in epileptiform convulsions due to coarse organic lesion 
of the brain. The best results are obtained from it in nocturnal epi- 
lepsy, in petit mal, and in pale, delicate, and anasmic subjects, with cold 
hands and feet, blue skin, and weak heart. 

In neuralgia belladonna affords relief, although not equal to some 
other agents. Given hypodermatically {see post), it is often very effec- 
tive. In any case, its use must be persisted in ; full doses are neces- 
sary, and physiological effects must be produced and maintained for 
some time. A solution of atropia is the best form for the stomach ad- 
ministration. DysmenorrJicea, when neuralgic in character, and ova- 
rian neuralgia, may be permanently removed by belladonna. It is 
useful in these cases to combine it with synergistic remedies. IJ. Ext. 
belladonna;, grs. iv ; ext. stramonii, grs. v ; ext. hyoscyami, g'rs. v ; 
quinise sulphat., 3ij. M. ft. pil. no. xx. Sig. One pill two or three 
times a day. "When anasmia exists, iron may be added to this formula. 

No single ageut has been as uniformly successful in the treatment 
of nocturnal incontinence of urine as belladonna. This morbid state 
is due to several conditions, and belladonna is not equally successful in 
all : nocturnal incontinence may be due to an excess in the acidity of 
the urine, which renders it unduly stimulating; to relaxation of the 
sphincter vesicas ; to an irritability of the mucous membrane, in conse- 
quence of which erroneous impressions are communicated to the brain. 
Belladonna gives relief in the two last-named conditions. The atropia 
dissolved in the urine acts locally on the nerves of the mucous mem 



BELLADONNA. 855 

brane, diminishing- their irritability ; tlic sphincter is put into a state of 
tonic contraction by reason of the systemic effect, which includes, of 
course, the sympathetic system. The error is often committed of giving 
too little of the remedy ; systemic effects must be produced, and chil- 
dren, compared with adults, are insusceptible to the action of bella- 
donna. The best form for administration, because less disagreeable and 
more constant in effect, is a solution of atropia. 

Nocturnal seminal losses, as respects mechanism of production, mak- 
ing allowance, of course, for difference of seat, have a strong analogy 
with nocturnal incontinence of urine. This trouble may be considered 
a morbid state, only, when the losses are frequent and affect the health. 
Bromide of potassium best relieves spermatorrhoea, so called, when it is 
largely physiological and due to a normal plethora ; belladonna is most 
serviceable when the genitalia are relaxed, the emissions flowing with- 
out force, and without a distinct dream and orgasm. 

Atropia is a remedy of the greatest importance in the practice of 
ophthalmology. As it dilates the pupil, diminishes the intraocular press- 
ure, contracts the arterioles, and acts topically on the sentient nerves, 
it is obvious that its field of utility is wide, and its therapeutic power 
great. 

In phlyctenular keratitis atropia renders the greatest service ; it 
diminishes the photophobia and blepharospasm, and lessens the blood- 
supply by contracting the vessels. It has a still more beneficial action 
in iritis ; it prevents adhesions, anterior and posterior, and by dilata 
tion of the pupil so compresses the vessels as to jugulate the inflamma- 
tory process. When the cornea is perforated, herniary protrusion and 
adhesion of the iris are prevented by dilating the pupil. For these pur- 
poses a four-grain solution of atropia is the proper strength for instil- 
lation into the eye. When it is desirable to suspend the power of 
accommodation, in cases of hypermetropia to determine the refraction of 
the eye, and in astigmatism to ascertain the difference in the meridians, 
atropia is used. A weak solution only is employed, to dilate the pupil 
for a brief period, in order to facilitate the examination of the fundus 
of the eye. Dilatation of the pupil with atropia is also necessary in 
the examination of cataract, especially in the early stages of its forma- 
tion. It should be remembered that strong solutions of atropia in- 
stilled into the eyes may, by subsequent absorption, produce atropinism, 
and to such an extent as to occasion solicitude. 

In certain affections of the skin belladonna is useful, viz., in the 
cutaneous neuroses, prurigo, herpes zoster, erythema, and eczema, etc 
Cases of these affections which resist ordinary treatment, yield to bella- 
donna. The tincture, or the alkaloid, in suitable doses, may be given 
in quantity sufficient to maintain a slight physiological action. Hyper- 
idrosis (colliquative sweating), unilateral sweating, and other forma 
of profuse transpiration through the skin, are arrested by the internal, 



356 EXCITO-MOTORS. 

and, in some cases, by the local application of the belladonna prepa- 
rations. 

No remedy is so generally effective in relieving the sweats of 
phthisis as atropia. The one-sixtieth of a grain at bedtime usually 
suffices. The author was the first to indicate this use of atropia in his 
" Prize Essay." Not only is atropia antagonistic in action to that con- 
dition of the sudoriparous glands resulting in the sweats of disease, but 
it equally antagonizes the hyperidrosis produced by such drugs as jabo- 
randi. 

In connection with the subject of the use of atropia in the night- 
sweats of phthisis, it may be proper for the author to state that he has 
observed cases of phthisis which appear to him to have been remark- 
ably improved by the continued use of this remedy. 

Hypodermatic Use op Atropia. — The solution usually employed 
for this purpose is two grains of the sulphate of atropia tc an ounce of 
distilled water, the dose of which ranges from two to five minims. 

There are two forms of neuralgia in which the subcutaneous use of 
atropia has been most signally useful : tic-douloureux and sciatica, 
more especially the latter. Atropia is not as effective in the treatment 
of the neuralgias in general as morphia, and the systemic effects of the 
former are much more unpleasant than those caused by the latter. 
Nevertheless, when morphia fails or disagrees with the patient, atropia 
may be used with confident expectation of its affording relief. We 
owe to Hunter our knowledge of the fact that atropia has a very special 
utility in tic-douloureux and sciatica. The merely subcutaneous injec- 
tion of atropia does not afford the same degree of relief as its deep 
injection in the neighborhood of the affected nerve-trunk. Further- 
more, a decided impression must be made on the cerebrum, in order to 
obtain the best results. The largest doses compatible with the safety 
of the patient must be used — generally the one-fiftieth of a grain to the 
one-thirtieth. If the remedy is employed in sufficient quantity, and well 
inserted into the tissues about the nerve, decided curative results may 
be expected from it in these two forms of neuralgia. When relief fol- 
lows the injection of atropia, it is apt to be more permanent than when 
the same degree of relief is obtained from morphia. We have the high 
authority of Dr. Anstie for the assertion that atropia is exceptionally 
serviceable in peri-uterine and dysmenorrhoeal neuralgia. The eminent 
Dr. Weir Mitchell asserts that atropia in traumatic neuralgias is "sim- 
ply useless," and, as his power of accurate observation is unquestioned, 
and his clinical opportunities vast, we may accept this conclusion as final. 

Muscular cramp, from injuries to the nerve-trunk, are often remark 
ably relieved by injections of atropia into the substance of the affected 
muscles. The so-called "late rigidity," as a result of which the mem 
bers may be put into very injurious positions, is occasionally removed 
or diminished by the same expedient, viz., injecting a small quantity of 






BELLADONNA. 357 

atropia ( T £^ of a grain) into the contracted muscles. This result does 
not ameliorate the condition of the patient to any greater extent than 
that of affording relief to an inconvenient deformity. 

The insomnia of mental disorders, and of delirium tremens, may be 
overcome by the hypodermatic injection of atropia when the following 
indications for its use are present : Ccma vigil, great restlessness, weak 
action of the heart, coldness of the surface, cyanosis, clammy sweat. 
When there is a condition of hyperemia of the cerebro-spinal centres, 
excitement with elevated pulse-rate and increase of arterial tension, 
atropia can only do harm. 

The treatment of asthma by belladonna, administered by the stom- 
ach and in the form of fumigation, has already been referred to. The 
hypodermatic injection of atropia is much more effective. From -j-J^ 
to -fa of a grain may be used for this purpose ; but, as the relief comes 
from the systemic effect, it is not necessary to inject the solution in the 
neighborhood of the pneumogastric, as practised by Courty. In order 
to procure the greatest relief, the injection should be made at the be- 
ginning of the asthmatic paroxysm, and succeeding attacks should be 
anticipated by inducing atropinism at the first warning of a seizure. 

Vomiting of pregnancy, when obstinate and resisting other means, 
is sometimes arrested promptly and permanently by the subcutaneous 
injection of atropia in small quantity (-j-i^g- of a grain). Sea-sicJcness 
is relieved in the same way. In these maladies, it is better to insert 
the injection in the epigastrium. 

Cramp of the hollow muscular organs — hepatic, intestinal, uterine, 
and renal colic — may all be relieved by the subcutaneous injection of 
atropia, but the most satisfactory results are produced by the combined 
use of atropia and morphia. 

External Application op Belladonna Preparations. — The 
chloroformic solution of atropia is an excellent external application to 
relieve pain in nerves superficially situated. IJ • Chloroformi, spts. vini 
rect., aa^ss; atropia, grs. v. M. Sig. Apply on lint to painful part, 
and cover with oiled-silk. The same application to the epigastrium 
sometimes arrests obstinate vomiting, cerebral or reflex, as for example 
the vomiting of pregnancy, sea-siclcness, etc. A belladcnna-plaster is 
an excellent application to relieve the chest-pains of phthisis, to allay 
irritability of an over-excited heart, to diminish the pains and soreness 
of lumbago, myalgia, etc. 

Excessive sweating of a part, as for example, unilateral sweating of 
the head, may be removed by brushing over the affected surface a solu- 
tion of atropia (grs. iv — 3 j). 

There is no doubt that belladonna has the power to arrest the secre- 
tion of milk, in the same way that it stops the cutaneous transpiration, 
for the milk-gland is only an enlarged sebaceous gland whose function 
is differentiated from that of other sebaceous glands of the body. When 



358 EXCITO-MOTORS. 

it is desirable to arrest the secretion of milk, the gland may be en- 
veloped by a belladonna-plaster, or the ointment of belladonna may be 
carefully rubbed into the integument. These are rather disagreeable, 
sticky applications, which soil the clothing. A much more elegant 
method of applying this treatment is to envelop the breast in lint wetted 
with a solution of atropia, four grains to the ounce of rose-water. As 
systemic effects may be produced by such an application, when the 
pupils dilate and the mouth becomes dry, it should be removed. In- 
flamed breasts may be treated in the same way. The mode of action 
of the belladonna preparations is quite obvious : the irritability of the 
terminal filaments of the nerves is allayed by the direct action of the 
atropia, and the arterioles are made to contract, thus diminishing the 
blood-supply to the inflamed tissue. 

Other superficial inflammations are subdued by the same treatment, 
as, for example, abscesses, boils, carbuncles. A plaster made of bella- 
donna extract may be kept in contact with the inflamed tissue, or the 
solution of atropia, above recommended, may be used. 

Pruritus of the vulva, vaginismus, fissure of the anus, are some- 
times relieved, as if by magic, by the use of the atropia solution above 
recommended. 

Whenever atropia is used locally for the relief of inflammatory pain 
and swelling, the efficiency of the application is much increased by the 
addition of morphia, or morphia and chloral, according to formulae to be 
given hereafter in the article on the latter drug. 

Secondary Products of Atropia. — Some remarkable products 
have lately been obtained from atropia by chemical processes. The 
first step consisted in the discovery, by Kraut and Lossen, simultane- 
ously, that atropia may be split up into tropine and tropic acid. Sub- 
sequently, Prof. Ladenburg succeeded in the synthesis of atropia by a 
combination of these two secondary products. If the salts, of tropine 
are treated w T ith dilute hydrochloric acid, alkaloids are produced, to 
which Ladenburg has given the name tropeins. Homotr opine is an 
alkaloid obtained from the amygdalate of tropine. The artificial atro- 
pia, prepared as above described, has precisely the same effects as the 
original alkaloid. 

Effects of Homotr opine. — The preparation of this base now used is 
the hydrobrornate. The physiological action of this new salt has been 
studied by Ringer and Tweedy, among others. Ringer finds that 
like atropia homotropine paralyzes and tetanizes, but the tetanizing 
effect which follows in forty-eight hours or more in the former, occurs 
at once in the latter. The paralyzing action is not in the nerves or 
muscles, for they respond to electrical stimulation, but in the cord, 
which is also the case with atropine. Homotropine, like atropine, in- 
creases the action of the heart by paralyzing the intra-cardiac inhibi- 
tory apparatus, and it also antagonizes muscarine. In man there is a 






BELLADONNA. 859 

marked distinction as regards the action of atropine and homotropinc 
on tlie heart ; while the former accelerates the heart considerably, the 
latter retards the beat from tin to twenty per minute, and also makes 
the action irregular. Ilomotropine also antagonizes the action of pilo- 
carpine, but it requires relatively more than of atropine to accomplish 
this result. Ringer sums up his observations with the remark, "Ilo- 
motropine, then, appears to possess many of the properties of atropine, 
but in a weaker degree." 

Tweedy remarks that, as regards the action of atropine and homo- 
tropine relatively on the eye, the action of homotropinc on the iris and 
ciliary muscle is really very powerful while it lasts. It widely and 
fixedly dilates the pupil in from fifteen to twenty minutes, and it acts 
on the accommodation in an equally rapid manner. Its effects pass 
off rapidly, and in twenty-four hours the accommodation is restored, 
although the pupil is yet a little dilated. The application of horao- 
tropine solution to the eye is entirely unirritating. For these reasons 
homotropinc becomes a valuable substitute for atropia in ocular thera- 
peutics, but it cannot be substituted for atropia in the general diseases 
in which the latter has been found useful. 

Authorities referred to : 

Bartiiolow, Dr. R. Prize Essay of the American Medical Association, 1S69. Tlie 
Physiological Effects and Therapeutical Uses of Atropia and its Salts. 

Ibid. Manual of Hypodermic Medication, second edition, 1873. 

Bezold und Bloebaum. Untcrsuch. aus. phys. Laborat. in Wurzburg. Quoted by Stille. 

Botkin, Dr. S. VircAow's Archiv, vol. xxiv., p. 85. 

Donders. On the Anomalies of Accommodation and Refraction of the Eye, Sydenham 
Society edition. 

Eilenbirg, Dr. Albert. Lehrbuch der functioncllcn Nerveukranl-hcitcn, Berlin, 1871, 
p. 168. 

Fluckiger amd Hanbury. Pharmacographia, pp. 407, 411. 

Fraser, Dr. Thomas R. An Investigation into some Tetanic Symptoms produced by 
Atropia in Cold-blooded Animals. From "Transactions of the Royal Society of Edin- 
burgh," vol. xsv. 

Note.— Other references omitted for lack of space. 

Stramonium. — Leaves and seed of datura stramonium. Stramoinc, 
Fr. ; Stechapfel, Ger. 

Stramonii Folia. — Stramonium-leaves. 

Stramonii Semen. — Stramonium-seed. 

Extractum Stramonii Folionan. — Extract of stramonium-leaves. 
Dose, gr. -£— gr. j. 

Extractum Stramonii Seminis. — Extract of stramonium-seed. Dose, 

g r - fr~ gr- ss - 

Tinctura Stramonii. — Tincture of stramonium. Dose, m. v. — 3 ss. 
Unguentum Stramonii. — Ointment of stramonium. 
Composition. — The alkaloid of stramonium — daturia — is chemi- 
cally and physiologically, nearly, identical with atropia. It is con- 



360 EXCITO-MOTORS. 

tained in the seeds in the proportion of about one-tenth per cent., and 
in the leaves in much smaller quantity. It exists in the plant in com- 
bination with malic acid. The seeds contain a fixed oil in considerable 
quantity. 

Antagonists, Incompatibles, and Synergists, are the same as for 
belladonna. In the case of poisoning by stramonium, which is not un- 
common in this country, the seeds, which usually are taken by chil- 
dren, must be evacuated by an emetic. Unless distinct symptoms fol- 
low, no further treatment may be necessary ; if, however, marked dila- 
tation of the pupil, hallucinations, and active delirium are produced, 
the physiological antagonist becomes necessary. Tincture of opium 
should be administered until some contraction of the pupil, lessening 
of the pulse-rate, and cessation of the delirium, occur. If then, normal 
sleep comes on, the pupil, heart, and lungs functionating normally, no 
further interference will be necessary. In cases of poisoning in chil- 
dren, it is particularly desirable to employ the opium with caution, 
since opium narcosis may readily be substituted for stramonium- 
poisoning. 

Hyoscyamus. — Leaves and seed of hyoscyamus niger. Jusquiame, 
Fr ; JBihenkraut, Ger. 

Hyoscyami Folia. — Hyoscyamus-leaves. 

Ilyoscyami Semen. — Hyoscyamus-seed. 

JExtractum Ilyoscyami AlcoJiolicum. — Alcoholic extract of hyoscy- 
amus. Dose, gr. -J — gr. j. 

JExtractum Ilyoscyami. — Extract of hyoscyamus. 

Extractum Hyoscyami Fluidum. — Fluid extract of hyoscyamus. 
Dose, m. v — 3 ss. 

Tinctura Hyoscyami. — Tincture of hyoscyamus. Dose, 3 ss — 3 ss. 

Composition. — Hyoscyamus contains an active principle (hyoscya- 
mia), a fatty oil, and the leaves are rich in nitrate of potassium. The 
seeds possess a larger quantity of hyoscyamia than the leaves. 

Antagonists, Incompatibles, and Synergists, are the same as for 
belladonna. The observation of Ladenberg, that hyoscyamia and du- 
boisia are identical, is important, and if confirmed will facilitate the 
introduction of the latter into practice. As hyoscyamia is difficult to 
procure and very expensive, and as duboisia, on the other hand, will 
probably be very readily procured in any quantity, it is certain that 
the latter will be substituted for the former. Chemical facts of this 
kind must be acted on with caution. Identity of chemical constitu- 
tion does not always mean identity in physiological action and in ther- 
apeutical power. Differences in molecular arrangement, not apprecia- 
ble by chemical analysis, may influence, to a great extent, the mode of 
action. The clinical facts do not, thus far, warrant the adoption of 
the view that hyoscyamia and duboisia are mutually convertible. 



IIYOSCYAMUS. 361 

Physiological Actions. — As atropia, datura, and hyoscyamia, 
are similar if not identical in chemical composition and in physiolog- 
ical action, the remarks already made in regard to the actions and 
use of belladonna are applicable to stramonium and hyoscyamus. 

To these alkaloids must be added duboisia, which by Ladenhurg is 
held to be identical with hyoscyamia. Studied from the physiological 
standpoint, daturia and hyoscyamia arc regarded as identical in their 
effects by Oulmont and Laurent. As daturia is not employed, owing 
to its scarcity, and as hyoscyamia has been the subject of considerable 
study and clinical observation, we refer, in the following remarks, 
wholly to this alkaloid. 

Hyoscyamia, as it occurs in commerce, prepared chiefly by Merck, 
of Darmstadt, is in two forms, a whitish crystalline solid, which is 
represented as chemically pure, and a dark, resinous mass, having a 
strong, mouse-like odor, which is rather a concentrated extract, but 
appears to be little if at all inferior to the pure alkaloid. It is recom- 
mended by Prideaux to dissolve it in a mixture of sulphuric ether, 
alcohol, and water, in the proportion of one grain to twenty minims — 
alcohol eight minims, spirit of sulphuric ether six minims, and water 
ten minims. It may be administered, hypodermatically, in this form, 
or, if too strong, by the addition of equal parts of spirit and water; 
and it may be prepared for internal use from the above solution, by 
adding water and any flavoring sirup. The dose, by subcutaneous in- 
jection, ranges from one-sixtieth of a grain to one-twelfth, and by the 
stomach from one-sixtieth to one grain. 

Hyoscyamia causes the same dryness of the mouth, dilatation of 
the pupils, flushing of the face, rapid action of the heart and of the 
lungs, the busy delirium with hallucinations and illusions, which are 
caused by atropia, but its effects in these directions are less in degree. 
In the various observations which have now been made on man, with 
the considerable doses which have been found necessary in some cases, 
it has been definitely ascertained that hyoscyamia has somewhat less 
than atropia of the deliriant action and much more hypnotic effects. 
As regards the mechanism of its action on the pupil, on accommoda- 
tion, on the heart and respiration, there is no actual difference between 
the two alkaloids. 

The elaboi-ate investigations of MM. Oulment and Laurent have 
conducted them to the following conclusions : Hyoscyamia and da- 
turia act especially on the sympathetic system, in small or moderate 
doses, stimulating the vaso-motor fibres and raising the arterial tension, 
and in large doses paralyzing the vessels and lowering the arterial 
tonus. These effects are produced after section of the vagi. These 
alkaloids differ in the effect on the heart — hyoscyamia rendering the 
cardiac movements more regular, and daturia causing intermittence. 
By direct contact, both alkaloids slow and finally stop the heart's 



362 EXCITO-MOTORS. 

action. Both accelerate the respiratory movements. In moderate 
quantity both increase the intestinal movements ; in large doses arrest 
them. As regards the nervous system of animal life, they are both 
without action on the motor functions, but in toxic doses they blunt 
the cutaneous sensibility. They do not affect the contractility of 
muscular fibre. Their action in dilating the pupil is due to stimula- 
tion of the sympathetic, and not to paralysis of the third nerve. The 
various phenomena arising from the administration of these alkaloids 
are referred by Oulment and Laurent to the circulatory disturbances 
— to the increased distribution of blood. The action is soon ended, the 
alkaloids being eliminated by the urine. 

There is, it is obvious, a close correspondence in the effects of 
hyoscyamia and atropia, as in chemical structure. But as differ- 
ences in molecular arrangement may exist in the constitution of 
these alkaloids, so variations must occur in their physiological ac- 
tions. 

Therapy. — The possession of decided hypnotic qualities has led to 
the use of hyoscyamia in the treatment of various mental disorders 
(Prideaux, Lawson, and others). Prideaux makes the important prac- 
tical distinction, that it acts with different degrees of rapidity and 
potency under varying conditions of insanity. In acute mania with 
depression, one-sixteenth of a grain will have a marked effect, while 
in the excitement of chronic mania large doses will be necessary. In 
chronic mania with exacerbations, he gives one-quarter, one-half, and 
even one grain by the stomach, or one-tenth of a grain, subcutaneously. 
The latter mode of administration he regards preferable in these cases. 
In cases of mania with great motor excitement, and of a destructive 
character, Prideaux regards hyoscyamia as " the most rapid and reli- 
able narcotic we possess." In the epileptic mania of the epileptic 
status, he says, it diminishes the number and violence of the attacks. 
In delusional insanity he finds it brings about under favorable circum- 
stances mental restoration. In chronic dementia, with destructive ten- 
dencies and sleeplessness, improvement is sometimes noted from the 
persistent use of small doses. Gill, Ringer, and Lawson, have also had 
good effects from hyoscyamia, in suitable cases, as a hypnotic. 

Stramonium and hyoscyamus may be used like belladonna for the 
relief of painful affections, the neuralgias ; but they possess no special 
advantages over their more powerful congener. Oulmont has used the 
hypodermatic injection of hyoscyamia with remarkable success in sev- 
eral cases of neuralgia, but he does not regard it as more conspicuous 
and rapid in this disease than are opium and belladonna. Stramonium 
is used with advantage in the treatment of dysmenorrhea. t>. Ext. 
stramonii, ext. hyoscyami, ext. opii, aa gr. vj. M. ft. pil. no. xij. Sig. 
One pill every three, four, or six hours. This combination gives great 
relief in dysmenorrhea, and may also be serviceable in neuralgia. 



STRAMONIUM AND D.YOSCYAMUS. .'50:5 

In affections characterized by spasm, as asthma, laryngeal cough, 
hepatic, intestinal, renal, and uterine colic, stramonium and hyoscyamus 
may be given with advantage, in place of or in combination with bella- 
donna. The hypodermatic injection of hyoscyamia or daturia is an 
excellent expedient for procuring relief in these cases, but these alka- 
loids are not more effective than atropia. Hyoscyamus, especially in 
the form of tincture, is frequently prescribed in irritable states of the 
bladder due to the presence of stone, enlargement of the prostate, and 
in catarrh of the bladder arising by transference of irritation from the 
urethra. It should not be forgotten that liquor potassa?, so much pre- 
scribed in a mixture with hyoscyamus, is incompatible. 

M. Oulmont refers, in terms which may seem to be exaggerated, to 
the great efficiency of hyoscyamia in the treatment of mercurial tremor, 
senile tremor, paralysis agitans, locomotor ataxia, and tetanus. In mer- 
curial and senile tremor cures were obtained, but, as might be expected, 
only amelioration in paralysis agitans, locomotor ataxia, and tetanus. 
The dose -which Oulmont found effective was the one-thirty-second of 
a grain of hyoscyamia, gradually increased to the one-fifteenth of a grain. 

The hypnotic quality is much more conspicuous in hyoscyamus than 
in belladonna or stramonium. In children it has long been known that, 
when opium is not well borne, hyoscyamus is an efficient substitute. 
Recent experience in asylum practice has shown that hyoscyamus in 
large doses is a very valuable hypnotic. According to Dr. Campbell, 
two and a half drachms of the tincture are equivalent in hypnotic power 
to thirty graius of chloral hydrate. In order to procure efficient hyp- 
notic effects, from two drachms to an ounce of the 'tincture is necessary, 
and this large quantity appears to be free from danger. 

Extract of hyoscyamus is used in combination with purgatives, with 
the object — which abundant clinical observation confirms — of rendering 
their operation more efficient, and, at the same time, less drastic. 

The ointment of stramonium is a favorite application to irritable 
ulcers, superficial inflammations, etc. 

Authorities referred to : 

Bucknill and Toke. Manual of Psychological Medicine, London, 1874, p. 727. 

Campbell, Dr. Journal of Mental Science, No. Ixxx., 1871. 

Fronmuller, Dr. Klinische Studien iiber die schlafmachende Wirhung der narkoti- 
schen Arzneimittel, Erlangen, 1875, p. 70. 

Husemann, Dr. Theodor. Handbuch der gesammlcn Arzneimittellehre, zweiter Band, 
p. 1115, et seq. 

Laurent, M. le Dr. De V Uyoscyamine el de la Daturine. Thise. 

Oulmont, M. le Dr. De V Hyoscyamine et de son Action dans les Nevroses. Bulletin 
General de Tlierapeutique, vol. lxxxiii., p. 481. 

Prideaux, E. The Action and Uses of Hijosciaminc. Lancet, 1879, September 27, 
October 4. and 11. 

Trousseau et Pidoux. Traite de Therapcutiquc el de Matib-e Medicale, tome second, 
kuitiiime 6dition, p. 202. 



364 EXCITO-MOTORS. 

DubOisia. — Duboisia Myoporoides, of the Solanaceae. 

Preparations. — There are no official preparations. It has "been 
used chiefly in the form of extract, and salts of the active principle. 
The dose of the extract is gr. \ — \. 

Composition. — The important constituent is an alkaloid — duboi- 
sine, or duboisia — which possesses the medicinal powers and properties 
of the plant. It combines with acids to form salts which are freely 
soluble in water. As regards its chemical relations, duboisia strongly 
resembles atropia, but differs in some particulars. The dose of a salt 
of duboisia is y^-g- to ■£$ of a grain. 

Antagonists and Incompatibles. — The caustic alkalies destroy 
the active principle, and consequently prescriptions containing them 
will be inert, except as to the effects of the alkali. The physiological 
antagonists are the same as those of atropia ; thus physostigmine and 
muscarine counterbalance the action of duboisia in almost the entire 
range of power, and opium in a limited degree. Duboisia antagonizes 
pilocarpine, as respects, at least, the most conspicuous and important 
properties of the latter. In case of poisoning, emetics and the stom- 
ach-pump must be used, and the systemic effects opposed by the sub- 
cutaneous use of physostigma, muscarine, or morphia, cautiously, and 
possibly pilocarpine ; but further researches are necessary as to the 
antagonism of the last named. 

Synergists. — The actions of duboisia are promoted by the other 
agents of the group, especially by belladonna, stramonium, and hyoscy- 
amus. The effects of atropia and duboisia correspond to a remarkable 
extent, but there are points of difference, as follows : Duboisia is twice 
or more soluble in water than atropine ; it has stronger basic proper- 
ties, and it reacts differently to sulphuric acid and bichromate of po- 
tassa ; it is less irritating to the conjunctiva, dilates the pupil more 
promptly, and its effects subside earlier. (Gerrard). 

Physiological Effects. — Dryness of the mouth, thirst, and some 
difficulty of swallowing, soon follow the adminstration of duboisia and 
more speedily after the subcutaneous injection of the alkaloid. The 
pulse is considerably accelerated ; the arterial tension rises, the face 
flushes, the pupil dilates, and the accommodation is paralyzed. Some 
frontal headache, tinnitus aurium, giddiness, and restlessness, especially 
in sleep, are experienced. Certain motor symptoms — uncertain gait, 
awkwardness of movement in walking, and muscular paresis — occur 
(Gubler). In animals mental excitement or delirium has been noted, 
but no confirmatory or opposing observations on man have thus far 
been reported. The tetanic symptoms which occur after some days in 
frogs poisoned by atropia, take place under the same conditions from 
duboisia. 

The acceleration of pulse and rise of tension first produced by du- 
boisia do not persist ; the pulse-rate and the tension fall after some 



DUBOISIA. 365 

hours, the excitement subsides, and a condition of stupoi* comes on 
which is not sleep, although it favors sleep (Gubler). I can confirm 
these important observations on the cerebral effects of duboisia. 

Therapy. — Thus far duboisia has been used only in ocular thera- 
peutics. The author has prescribed it in a case of puerperal mania with 
excitement, on the suggestion of M. Gubler, and with apparent advan- 
tage. There was always an increase of the maniacal excitement for a 
few hours after the hypodermic injection, but this was followed by 
the condition of stupor and mental calm. The improvement was rapid 
and followed so closely the administration of the remedy, that he could 
not doubt it was propter and not merely jyost hoc. 

As respects its use in ophthalmic diseases, it may be stated in gen- 
eral that duboisia is applicable under the same conditions as atropia, 
to which it is to be preferred, in many cases, it is probable. 

The advantages of duboisia, as compared with atropia,' are its 
greater rapidity of action in effecting dilatation of the pupil and 
paralysis of accommodation, the less irritation of the conjunctiva, 
and the more rapid recovery from the effects. It is, therefore, much 
more useful than atropia for determining the refraction of the eye, 
and for use in ocular therapeutics in general. 

Some unpleasant cerebral effects have been observed after instilla- 
tion into the eye (Seely). The author was given the opportunity, by 
the kindness of Dr. Seely, to examine the patient who experienced 
faintness and strange sensations in the head, but they were entirely 
subjective and mental, as no change in the circulation or respiration 
was to be seen. 

To relieve the night-sweats of phthisis and the various neuroses of 
the respiratory organs, and to stimulate the action of the heart, du- 
boisia will, probably, take the place of atropia. As an antagonist to 
morphia it is equally as effective as atropia, but as a hypnotic and 
anodyne, superior to the latter. 

Authorities referred to : 

Bancroft, Dr. Joseph. Tlie Lancet, March 2, 1878. 

Gerrard, Mr. London Medical Record, vol. vi., 1878, p. 156. 

Gubler, Prop. A. Bull. Gen. de Therap. vol. xeiv., p. 426. 

Laoersau, de, Prof. Bull. Gen. de Therap. supra, p. 862. 

Norris, Prof. W. F. The Am. Journal of the Med. Sci. April, 1879, pp. 466, et 
seq. Duboisia as a Mydriatic, etc. 

Kinger, Prof. Sydney. The Lancet, supra. 

Seely, Prof. W. W. Lancet and Clinic for 1879. Jan., Feb. Various articles on 
the use of Duboisia. 

Tweedy, Mr. John. Tlie Lancet, supra. On the Mydriatic properties of Duboisia, 
etc. 

Weeker, Dr. L. Bull. Gen. de Therap. supra, p. 337. De Vemploi compare de Veser- 
ine, de Vatropine, et de la duboisine en therapcutique oculaire. 



366 CEREBRAL EXCITANTS. 



B.— AGENTS EXCITING THE FUNCTIONAL ACTIVITY OF THE CEREBRUM. 

To this group belong those remedies usually classed together under 
the designation of antispasmodics. They are to a slight degree car- 
diac stimulants ; they increase the cutaneous circulation, and promote 
diaphoresis ; they also stimulate the bronchial mucous membrane, and 
favor expectoration. As a result in part of the increased rapidity of the 
circulation, the functions of the brain become slightly more active, ideas 
flow more freely, irregular mental excitement and muscular hyperkine- 
sis are moderated, and an orderly feeling of well-being is established. 
These effects are probably in part due to a direct action of these agents 
on the gray matter of the hemispheres, but our knowledge does not at 
present permit an exact statement of the nature of this impression. 
These agents do not in any quantity suspend the functions of the brain, 
and the temporary increase of activity which they produce is not fol- 
lowed by manifest depression. 

Camphora. — Camphor. Camphre, Fr. ; Campher, Ger. " A pecul- 
iar, concrete substance, derived from camphora officinarum, and purified 
by sublimation." 

Aqua Camphorce. — Camphor-water. Dose, 3 j — 3 j. 

Linimentum Camphorce. — Camphor-liniment. (Camphor, § iij ; 
olive-oil, § xij.) 

Linimentum Saponis. — Soap-liniment. (Soap, camphor, oil of rose- 
mary, alcohol, and water.) 

Spiritus Camphoraz. — Spirit of camphor. (Camphor, § iv ; alcohol, 
Oij.) Dose, m. v — m. xx. 

Camphora Monooromata. — Monobromide of camphor. Dose, grs. 
ij — grs. x (unofficial). 

Composition and Properties. — Camphor is found in colorless, trans- 
lucent, crystalline masses. One part dissolves in about 1,300 parts of 
water, but it is freely soluble in alcohol, ethers, oils, chloroform, bisul- 
phide of carbon, etc. Its odor is peculiar and characteristic. The 
formula for camphor is the following : C ,0 H 16 O. By distillation with 
chloride of zinc it is converted into cymol, and by oxidizing agents into 
camphoric and camphretic acids. 

Antagonists and Incompatibles. — The addition of water precipi- 
tates camphor from its spirituous solution. Alkaline and earthy salts, 
for example sulphate of magnesium, separate from its solution the 
small quantity of camphor contained in aqua camphors. Coffee, the 
arterial sedatives, cold, and depressing causes generally, antagonize its 
physiological action. 

Synergists. — All the remedies of this group, and alcohol, opium, and 
narcotic substances, increase the effects of camphor. 



CAMPHOR. 3G7 

Physiological Actions. — Applied to the skin, camphor produces 
redness, heat, and superficial inflammation, if the contact be sufficiently 
prolonged; to an open wound its effects are still more severe. Its 
taste is hot, aromatic, and pungent. In the stomach it causes a sensa- 
tion of heat, and may excite in large doses inflammation and ulceration. 
The symptoms common to irritant poisons may, therefore, be produced 
by camphor. After experimental doses in animals camphor has been 
detected in the blood of the mesenteric and portal vein, but not in the 
chyle or urine. In moderate doses (medicinal) it increases the action 
of the heart, elevates the arterial tension, and promotes cutaneous trans- 
piration ; it also produces mental exhilaration, even a gay and lively 
intoxication, and allays pain. In toxic doses, in addition to the local 
irritant action on the gastro-intestinal mucous membrane, and the conse- 
quent systemic effects, it lowers the pulse, the skin becomes pale, and 
the surface cold and moist, stupefies, diminishes the reflex functions of 
the spinal cord, and pauses convulsions, insensibility, and death ; but 
these cerebral phenomena are not separable from the reflex effects, on 
the nervous centres, of the violent gastro-intestinal disturbance. Some- 
times dysuria has been caused by camphor, and, in small doses, owing 
doubtless to the merely stimulant effects on the circulation, it increases 
the sexual appetite ; but, in large doses, it is antaphrodisiac. 

Camphor, alter absorption, is eliminated chiefly by the skin and 
bronchial mucous membrane, hence the breath and sweat of those using 
this substance smell of it strongly; but, when much camphor is taken 
in the solid form, it escapes with the fasces. 

Therapy. — Camphor enters into the composition of many dentifrices. 

Camphor is contraindicated in all inflammatory affections of the 
gastro-intestinal mucous membrane. In hysterical vomiting a few drops 
of the spirit (two to five), every half-hour or hour, will often give relief. 
Camphor is an efficient remedy in summer diarrhoea. It is usually 
combined with opium: R. Spirit, camphorse, tinct. opii, aa 3 ss. M. 
Sig. Ten to thirty drops every tico, three, or four hours. IjL Aqua 
camphorae, % iij ; tinct. lavendulae comp., 3 j ; tinct. opii, 3 j — 3 ij. M. 
Sig. A tablespoonful every hour or two. This is an excellent formula, 
omitting the opium, for flatulence, especially hysterical flatulence and 
the flatulent colic which so often occurs during the climacteric period. 
For the preliminary diarrhoea of Asiatic cholera camphor is largely 
used, and with very obvious benefit. A drop or two of the saturated 
tincture (Rubini's), or five to ten drops of the spirit, may be given with 
a little laudanum every half-hour or hour. Oppolzer gave the ethereal 
tincture with opium: fy. Camphorae, §j; etheris, 3 vij ; tinct. opii, 
3"j. M. Sig. Twenty to forty drops, as necessary. Camphor, which 
is very serviceable in the summer diarrhoea of children, may be given 
to these little subjects in milk, in which it is soluble in the proportion 
of one drachm to four ounces. 



368 CEREBRAL EXCITANTS. 

Spirits of camphor, in the form of vapor, is a useful inhalation in the 
incipiency of acute catarrh. Dr. Beard speaks in very enthusiastic 
terms of a camphor preparation which he has called " cold powder." 
This formula is as follows : " Oamphor five parts. Dissolve in ether to 
the consistence of cream. Then add carbonate of ammonium four parts, 
opium-powder one part." The dose of this ranges from three to ten 
grains. Dr. Beard finds this combination of " great value in breaking 
up colds, when taken in time, and in modifying their force when taken 
late." 

Oamphor was formerly much used in the treatment of asthma, but, 
at present, more efficient remedies have taken its place. The mono- 
bromide of camphor has proved decidedly beneficial in whooping-cough. 
Five grains, suspended in mucilage and sirup of tolu, may be given to a 
child three or four times a day. It is most serviceable in the spasmodic 
stage, but will do good at any period. 

Oamphor will allay cough and promote expectoration, hence its 
utility in chronic bronchitis, in capillary bronchitis when stimulants 
are needed, and in emphysema. In the so-called typhoid pneumonia 
camphor is serviceable as a stimulant, in small and frequently-repeated 
doses, to sustain the powers of life during the period of defervescence. 

In typhus and typhoid fevers, and in the exanthemata generally, 
camphor is used to accomplish two objects — to quiet delirium, subsultus, 
or restlessness, and to. overcome the cardiac depression. When very 
active interference is unnecessary the following can be used: R. Aqua 
camphora?, liq. ammonia acetatis, aa § ij. M. Sig. A tablespoonful 
every two hours. 

Attacks of nervousness and hysteria are relieved by camphor-julep, 
i. e., camphor rubbed up with mucilage. Some cases of delirium tre- 
mens are benefited by camphor, but it is impossible to indicate the 
special condition requiring it. Maniacal excitement, melancholia, and 
erotomania, have also been relieved by this agent, but a great uncer- 
tainty exists as to the indications for its employment. Large doses are 
necessary in these affections, and they should at first be tentative, for it 
is not possible in the present state of our knowledge to predict the 
results of any given trial. On the whole, but little dependence is to be 
placed on camphor; besides, more certain and effective remedies are 
now available for the treatment of these maladies. 

There appears to be a satisfactory clinical experience as respects 
the use of camphor to allay sexual excitement. Large doses (from ten 
to twenty grains) diminish the venereal appetite, and the vigGr of the 
erections ; hence the use of camphor in priapism, satyriasis, nympho- 
mania, chordee, etc. The following is a formula of Ricord: R. Cam- 
phorse, lactucarii, aa 3 j- M. ft. pil. no. xxx. Sig. One or two pills, or 
more, as necessary. For nocturnal seminal losses, with weakness and 
relaxation of the genitalia, the following formula is useful : R. Ergotine 



ASAFCETIDA. 309 

(aq. ex., Squibb's), 3ij; camphoric, 3 j. M.. ft. pil. no. xxx. Sig. Tico 
at bed-hour. A full dose of camphor will often arrest the strangury 
produced by blisters. 

Considerable testimony has been collected showing the value of 
camphor as a remedy in senile gangrene, and in hospital gangrene. 
Five to fifteen grains every four hours may be given in an emulsion, 
and powdered camphor may be applied freely to the sloughing surface. 
A clyster of camphor is an effective remedy against ascarides. 

Camphor was a favorite remedy with Dewees for dysmenorrhea. 
He gave ten grains in a mixture with mucilage and cinnamon-water, 
and repeated the dose in an hour or two if necessary. For after-pains, 
camphor (ten grains), in a mixture with a little morphia (one-eighth of 
a grain), is an effective remedy. 

External Uses. — A cataplasm of camphor, morphia, and flaxseed, 
applied to the cheek will relieve toothache. Camphorated oil is a mild 
counter-irritant, which is a useful external application for the relief of 
internal inflammations. The solution of camphor in ether has been ap- 
plied locally with benefit in erysipelas. Myalgia, lumbago, and neu- 
ralgia of superficial nerves, may sometimes be relieved by frictions 
with camphorated oil, or soap-liniment. Powdered camphor, freely 
sprinkled over the surface, is one of the means resorted to, and some- 
times with success, to prevent pitting of the face from variola. 

Authorities referred to: 

Beard, Dr. George M. Archives of Electrology, 1874, p. 272. 

Flcckiger and Hanbory. Pharmacographia, article Camphora. 

Gubler, Dr. Adolphe. Bulletin General de Therapeutique, December 30, 1871. 

IIarley, Dr. John. The Physiological Action of Camphor. The Practitioner, vcL 
ix., p. 210. 

Hcsemann, Dr. Theod. Handbuch der gesammten Arzneimiltellehre, Berlin, 1875, 
zweitcr Baud. 

Koiiler, Prof. Dr. Hermann. Handbuch der phys. TJicrapcuiik. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, vol. ii., article Camphor. 

Trousseau et Pidocx. Traite de Therap. et de Mat. Med., vol. ii., huitiume edition. 

Von Grisar, V. Pharmakodynamik der ath. Oele, Diss., Bonn, 1873. 

Asaftfitida. — Asafcetida. A gum-resinous exudation, obtained by in- 
cision, from the root of narthex asafcetida. Asafcetida, Fr. ; Teufels- 
drecJc, Ger. 

Emplastrum Asafoetidce. — Asafcetida-plaster. 

Mistura Asafcetida?. — Asafeetida-mixture. Dose, § ss — § ij. 

Tinctilra Asafcetida?. — Tincture of asafcetida. Dose, 3 ss — 3 ij. 

Pilula? Asafcetida?. — Pills of asafcetida. (Asafcetida and soap.) 
Dose, 1 — 4 pills. 

Pilulai Aloes et Asafcetida?. — Pills of aloes and asafcetida. (Asa- 
fcetida, aloes, soap.) Dose, 1 — 4 pills. 
£5 



370 CEREBRAL EXCITANTS. 

Piluloe Galbani Compositor. — Compound pills of galbamim. (Asa- 
foetida, galbauum, and myrrh.) Dose, 1 — 4 pills. 

Composition. — About one -half of the gross constituents of asa- 
foetida consists of resin. This is not wholly soluble in chloroform or 
ether. It contains a peculiar acid (ferulaic acid). Asafoetida also 
contains a sulphuretted and phosphuretted volatile oil, in the propor- 
tion of from three to five per cent. This oil is at first neutral, but be- 
comes acid by exposure to the air, and evolves sulphuretted hydrogen. 
It possesses in a high degree the disagreeable odor of the drug. 

Asafoetida also contains rnalic acid, and acetic, formic, and vale- 
rianic acids, are products of the watery distillation. There is- sufficient 
gum present also to form an emulsion with water. 

Antagonists and Incompatibles. — Acids, neutral salts, cold, and 
arterial sedatives, oppose the action of asafoetida. 

Synergists. — The gum-resins, the balsams, and the aromatics, es- 
sential oils containing sulphur and phosphorus, and alcohol and ether, 
promote the physiological and therapeutical activity of asafoetida. 

Physiological Actions. — Asafoetida possesses an extremely char- 
acteristic odor, and a pungent, rather hot, and faintly acrid taste. It 
excites by its presence in the fauces an increased flow of saliva. It 
stimulates secretion from the gastro-intestinal mucous membrane, pro- 
motes the appetite, improves digestion, and increases peristalsis. The 
faeces are somewhat softer, and are very offensive from the presence in 
them of sulphur and phosphorus compounds, resulting from the decom- 
position of the essential oil. In large quantity asafoetida causes 
nausea, vomiting, and purging. The active principle (the essential oil) 
undoubtedly slowly diffuses into the blood, for the odor of it is detect- 
able in the sweat and breath. Increased action of the heart, a higher 
temperature of the surface (subjectively, at least), more or less diapho- 
resis, and diuresis, have been observed to follow its medicinal adminis- 
tration. It acts as a gentle stimulant to the brain, induces a feeling of 
well-being, increases the flow of ideas, and causes, as the author has 
observed in one case, certainly, sufficient exhilaration cf a pleasant kind 
to be regarded as an intoxicant. 

Asafoetida is eliminated by the skin, intestinal and bronchi-al mucous 
membrane, and in small part by the kidneys. The functions of all these 
parts are increased in activity by the local stimulant effect. Partly due 
to the general rise of arterial pressure which it produces, partly to its 
local action in the process of elimination, and partly to its phosphorus 
compounds, asafoetida increases the menstrual flux, and, in both sexes, 
the venereal appetite. 

Therapy. — Asafoetida is used in the country of its habitat as a 
condiment. A little — very little — rubbed on the gridiron, improves 
the flavor of beefsteak. If it were not for its intolerable odor, and for 
the horrible eructations which follow its use, even when disguised in a 



ASAFCETIDA. 371 

sugar-coated pill, it would be much employed as a stomachic tonic in 
atonic dyspepsia accompanied by torpor of the intestines. For the 
flatulent colic of infants no remed3 r is better than mistura asafoetidce, 
which may be given in teaspoonful doses. It is especially in the flatu- 
lence of hysteria and hypochondriasis that this remedy is serviceable. 
It expels the flatus, promotes intestinal seoretion and digestion, and 
relaxes the bowels. In this way the mind is relieved, but the action 
of asafcetida extends beyond this improvement in the state of the 
chylopoetic viscera — -it induces a condition of mental cheerfulness 
which takes the place of the abnormal mobility of hysteria, and of the 
gloom of hypochondriasis. 

The official pill of aloes and asafcetida is an excellent combination 
for the relief of constipation, when associated with amenorrhoea. It 
is adapted, of course, to those cases in which there is a condition of 
anosmia rather than of plethora, and in which there exists a state of 
torpor of the ovaries, as well as of the intestinal canal. These conditions 
existing, the combined pill of aloes and asafcetida is indicated whether 
hysteria be present or not. 

The chronic scaly eruptions, chronic eczema, etc., especially when 
the skin is dry and harsh, are much improved by the persistent use of 
asafcetida. 

JSronChorrhcea, bronchitis after the acute symptoms have subsided, 
the cough maintained by habit which may succeed the whooping-cough, 
and the sympathetic cough of mothers, whose children are experiencing 
whooping-cough, are greatly benefited by asafcetida. IjL Mist, asafceti- 
das, § iv ; ammonii muriat., 3 j. M. Sig. A tablespoonful as necessary. 

Asafcetida, which was formerly much prescribed in asthma, whoop- 
ing-cough, and other neuroses of the respiratory organs, has been sup- 
planted by more efficient remedies. 

The disagreeable odor of asafcetida, which is a bar to its employ- 
ment in many of the diseases to the treatment of which it is very well 
suited, is not an objection to its use in hysteria, hypochondriasis, and 
epilepsy. The moral effect of its repulsive odor is not without influence 
in the psychic realm. But the effect of asafcetida is not simply on the 
imagination of the patient; it has constituents of very positive quality, 
which impress the brain. Hence the utility of asafcetida to arrest the 
hysterical paroxysm, and to relieve the numerous maladies in which the 
hysterical constitution disports itself. The remarks already made in re- 
gard to the action of asafcetida on the digestive functions in hypo- 
chondriacal subjects, render it unnecessary to speak more at length on 
the use of this remedy in hypochondriasis. Asafcetida is no longer 
employed in the treatment of epilepsy, except in the so-called hystero- 
epilepsy. The convulsions of childhood, from reflex irritation, are 
sometimes relieved by this remedy, but it is entirely without utility in 
convulsions arising from renal or cerebral disease. 



372 CEREBRAL EXCITANTS. 

Ammoniacum. — Ammoniac. A gum-resinous exudation from <lo- 
rema ammoniacum. Oomme ammoniaque, Fr. ; AmmoniaJcgummi l 
Ger. 

JEmplastrum Ammoniaci. —Ammoniac-plaster. 

Mistura Ammoniaci. — Ammoniac-mixture. (The resin is sus- 
pended by the gum in water.) Dose, ■ § ss — § j. 

Pilulaz JScillce Composite. — Compound pills of squill. (Squill, gin- 
ger, ammoniac, and soap.) Dose, 1 — 2 pills. 

Composition. — Ammoniac contains a volatile oil, which differs from 
the asafcetida oil in not containing sulphur. It has the odor of the 
drug. Ammoniac also contains gum and resin, the latter in the pro- 
portion of about seventy per cent. 

Antagonists, Incompatibles, and Synergists, same as for asa- 
fcetida. 

Physiological Actions. — The effects of ammoniac are similar to 
those of asafcetida, but it is much less active, owing to the fact, chiefly, 
that its volatile oil does not contain sulphur and phosphorus compounds. 

Therapy. — Ammoniac may be used for the same purposes as asa- 
fcetida, but it is much less efficient than the latter. At present its use 
is almost entirely restricted to chronic bronchial affections, in which 
the mistura is prescribed usually with the carbonate or chloride of am- 
monium. Ammoniac-plaster is sometimes used as a discutient to indo 
lent glandular and inflammatory swellings. 

Authorities referred to : 

Flttckiger and Hanbury. Pharmacogr aphid : 

Gobler, Dr. A. Commentaires Therapeuliqv.es. • 

Husemann, Dr. Theod. Handbuch, etc., zweiter Band, p. 987. 

Kobxer, Dr. Hermann. Handbuch, etc., erste Halfte, p. 392. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, fourth edition. 

Trousseau et Pidoux. Traite Therap. el Mat. Med., vol. ii. 

United States Dispensatory, thirteenth edition. 

Valeriana. — Valerian. The root of Valeriana officinalis. Valeriane, 
Fr. ; JBaldrianwurzel, Ger. 

Infusum "Valeriana). — Infusion of valerian. ( § ss — Oj. ) Dose, 
Iss — fij. 

Extractum Valerianae Fluidum. — Fluid extract of valerian. Dose, 
3 ss — | ss. 

Tinctura Valeriana. — Tincture of valerian. ( § iv — Oij.) Dose, 
3 ss — 3 ij. 

Tinctura Valeriana! Ammoniata.— Ammoniated tincture of vale- 
rian. ( \ iv — Oij spts. ammon. aromat.) 

Ammonii Valerianae. — Valerianate of ammonia. " Is a white salt, 
in the form of quadrangular plates, having the disagreeable odor of 
valerianic acid, and a sharp, sweetish taste. It deliquesces in a moist 



VALERIAN. ;!7;; 

air, but effloresces in a dry one, and is verj soluble in water and in 
alcohol. It is decomposed by potassa, with evolution of ammonia, and 
by the mineral acids with separation of valerianic acid, which rises to 
the surface in the form of oil." 

Oleum Valerianae. — Oil of valerian. Dose, m. ij — m. iv. 

Composition. — Valerian contains from one to two per cent, of an 
essential oil, which, if distilled from the perfectly fresh plant, has but 
little odor. In the process of drying of the root, or on exposure to the 
air of the oil distilled from fresh roots, valerianic acid is formed. As 
obtained from the dried root, the oil of valerian consists of valerianic 
acid, a camphor, valerene, and valerol. 

An acid strongly resembling valerianic is obtained by the oxidation 
of amylic alcohol ; but the two acids are not identical. The valerianio 
acid of pharmacy is, however, obtained in this way, and the various 
valerianates are products of the combination of the acid formed from 
amylic alcohol, with bases. 

Antagonists and Incompatibles. — Quinine, digitalis, ergot, and 
remedies acting similarly, antagonize the actions of valerian. 

Synebgists. — All the agents of this group, opium, alcohol, ether, 
etc., increase the action of valerian. 

Physiological Actions. — Valerian and its preparations have a hot, 
pungent taste, and a peculiar and disagreeable odor. A sensation of 
warmth at the epigastrium follows when it is taken into the stomach. 
In large doses, nausea, hiccough, eructations of the drug, vomiting, and 
diarrhoea, may be produced. In small doses no appreciable physiological 
effects are observed ; but in considerable doses the action of the heart is 
increased, the temperature of the surface rises, and diaphoresis occurs. 
As respects the nervous system, headache, vertigo, exhilaration of mind, 
spectral illusions, hallucinations, have, it is said, been produced by 
valerian ; but these results are by no means constant phenomena. 
According to Von Grisar (Kohler) oil of valerian reduces the reflex ex- 
citability, motility, and sensibility, and antagonizes the tetanizing action 
of brucia. 

The odorous principle — valerianic acid — appears in the sweat, breath, 
and also the urine. 

Theeapy. — The flatulence of the hysterical and hypochondriacal 
is quickly relieved by the tincture or fluid extract of valerian. 

It sometimes happens that a mild attack of spasmodic asthma may 
be relieved by valerian, but this by no means efficient remedy quickly 
loses its effect. Whooping-cough, laryngismus stridulus, and other 
neuroses of the respiratory organs, may be occasionally modified by this 
agent ; but it is by no means equal to many other remedies now avail- 
able. 

The chief therapeutic use of valerian is in the treatment of nervous- 
ness, hysteria, and hysterical disorders generally. There can be no 



374 CEREBRAL EXCITAXTS. 

difference of opinion as to its great value in these cases ; but as respocrj 
epilepsy, chorea, paralysis agitans, etc.', in which it was formerly used, 
it must suffice to say that it is now never prescribed. 

Under the impression that the physiological and therapeutical ac- 
tivity of valerian depends on valerianic acid, various valerianates have 
been introduced into practice. The only one which requires notice 
here is the valerianate of ammonia, which in the form of elixir is fre- 
quently prescribed in hysterical affections. Fluid extract of valerian 
has been used with advantage in diabetes insipidus and also in sac- 
charine diabetes, but the results are not permanent. It diminishes the 
amount of urinary water in both, and lessens the excretion of sugar 
in the latter, but these effects continue only while the remedy is 
given. 

Authorities referred to : • 

Fluckiger and Hanbury. Pharmacographia. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimitlellthre, zweiter Rand. 

Husemann, Drs. Aug. und Theo. Die PJlanzenstoffe. 

Kohler, Dr. Hermann. Handbuch der physiologuchen TTierapeuiik, etc., erste Halfte. 

Trousseau et Pidoux. Traiie de Therapeutique et de Mat. Med., huitieme- edition. 

United States Dispensatory, thirteenth edition. 

Serpentaria. — Serpentaria, Virginia snake-root. The root of aristo- 
lochia serpentaria, of aristolochia reticulata, and of other species of 
aristolochia. Racine de serpentaire, Fr. ; Virginische Schlangenwur- 
zel, Ger. 

Infusum Serpentaria. — Infusion of serpentaria. ( 3 ss — Oj.) Dose, 
3 ss— I ij. 

JExtractum Serpentaria} Fluidum. — Fluid extract of serpentaria. 
Dose, 3 ss — 3 ij. 

Tinctura Serpentarice. — Tincture of serpentaria. Dose, 3 ss — 3 ij. 

Composition. — Serpentaria contains a volatile oil, resin (a cam- 
phor), and a bitter principle, aristolochine, which is similar to qnassine. 

Antagonists and Incojipatibles. — The addition of water to the 
tincture renders it turbid. As the preparations of serpentaria contain 
tannin, the salts of iron are incompatible with them. Arterial seda- 
tives, depressants, ergot, etc., are opposed, physiologically. 

Synergists. — Camphor, valerian, ammonia, alcoholic stimulants, 
opium, favor the action of serpentaria. 

Physiological Actions. — Serpentaria has a warm, camphoraceous, 
pungent taste, and a characteristic odor. In small doses it increases the 
appetite, promotes secretion from the intestinal mucous membrane, and 
relaxes the bowels. In large doses it excites decided irritation, result- 
ing in nausea, vomiting, and diarrhoea. 

The action of the heart, the cutaneous circulation, and the tempera* 



SERrENTARIA. 375 

ture, are elevated by serpentaria. It promotes secretion from the bron- 
chial mucous membrane, and is expectorant. 

• Fullness of the head, headache, vertigo, exhilaration, are produced 
by full doses. As a rule serpentaria increases the urinary secretion, 
and it has very decided aphrodisiac effects. Increased vigor of the 
erections and priapism in the male, increased menstrual flow in the 
female, have been noted from its use in considerable doses. 

Therapy. — The therapeutical applications of serpentaria are dedu- 
cible from its physiological actions. It is a stimulant expectorant of 
very considerable value. In capillary bronchitis, typhoid pneumonia, 
and chronic bronchitis, it sustains the powers of life, and promotes ex- 
pectoration. In the acute pulmonary inflammations it is frequently 
prescribed with carbonate of ammonia, when stimulants of this kind are 
required. I>. Infus. serpentariae, % iv; ammonii carbonat., 3 j. M. Sig. 
A. tablespoonful every three hours. This combination is especially 
serviceable about the period of crisis in pneumonia ; it lessens the de- 
pression which ensues from the rapid defervescence of the fever, and it 
hastens the transformation of the inflammation products and favors 
their elimination. Most excellent results are obtained by the use of 
serpentaria with carbonate of ammonia in the capillary bronchitis of 
children, 1}. Ext. serpentariae fluid., § ss ; ammonii carb., 3ij; syrp. 
tolutan., § iss. M. Sig. A teaspoonful every two, three, or four hours. 
In diphtheria, scarlatina, and other exanthemata, when there exists 
much depression, serpentaria is a useful stimulant. The infusion is an 
excellent detergent application to the throat (as a gargle) in the above- 
mentioned disorders with local manifestations in the fauces. 

In typhoid, typhus, and remittent fevers, serpentaria is indicated, 
and is unquestionably serviceable when much depression exists. It is 
apt to increase the_ diarrhoea of typhoid, however, and must be given 
with caution when the intestines are very irritable. It has been as- 
serted that serpentaria has decided antiperiodic powers and it enters 
into the composition of Huxham's tincture, but it is greatty inferior to 
many other antiperiodics without reference to quinia. 

The emmenagogue properties of serpentaria render it useful in 
amenorrhoea of anaemia and chlorosis. When relaxation of the genital 
organs, feeble erections, and too ready ejaculation, render intromission 
uncertain, serpentaria will not unfrequently afford relief and restore the 
waning sexual power. 

Authorities referred to : 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, p. 893. 
Stille, Dr. Alfred. Therapeutics and Materia Medica, fourth edition. 
United States Dispensatory, thirteenth edition. 



376 CEREBRAL EXCITANTS. 

Cannabis Indica. — Indian Hemp. Chanvre Indien, Fr. ; JETanf- 
kraut, Ger. • 

Cannabis Americana. — American Hemp. 

Composition. — The physiological activity of hemp is influenced 
largely by soil and climate ; for, although in botanical characters Indian 
and American hemp are identical, the Indian hemp possesses decidedly 
more narcotic power. Indeed, until recently, it was supposed that 
American hemp was devoid of the peculiar properties possessed by the 
Indian. We owe to H. C. Wood the demonstration of the fact that 
American hemp does really have effects similar in kind to, but much 
less in degree than, those caused by the Indian. 

The most important constituent of hemp is a peculiar resin, which 
possesses the active powers of the plant. By distillation of the leaves 
and stems, a peculiar volatile oil is obtained ; and this is divisible into 
cannabene, a very light hydro-carbon, and hydride of cannabene, a solid 
crystalline substance. 

An impure resin, collected in an imperfect and crude way from the 
leaves and stems, is known as eharas, or churrus. Bhang consists of 
the dried leaves and stalks made into a confection with preserved fruits 
and aromatics, and, in this form, constitutes the well-known hashish. 
Gunjah is the female, flowering plant, dried, from which the resin has 
not been extracted. 

Preparations. — Tinctura Cannabis Indicm. Tincture of Indian 
hemp. Dose, 10 minims to 60 (480 grains of extract — Oij alcohol). 

Extractum Cannabis Americana}. — Extract of American hemp. 
Dose, half-grain to two grains, or more. 

Extractum Cannabis Indicm. — Extract of Indian hemp. Dose, 
half-grain to two grains, or more. 

No arbitrary rules for the dose can be laid down. In beginning the 
use of any newly-made preparation, it is safer to commence with the 
minimum dose. Having, by gradually increasing the quantity, ascer- 
tained the physiological activity of that particular specimen, it may 
then be pushed according to the necessities of the case. 

Antagonists and Incompatibles. — The caustic alkalies, the acids, 
strychnia, and induction electricity, oppose the actions of hemp. In 
cases of poisoning, the stomach should be evacuated, and symptoms be 
combated as they arise. Strychnia may be injected hypodermically, 
and the respiration be maintained by faradization of the respiratory 
muscles. As, however, hemp possesses but feeble toxic power, cases 
of acute poisoning have never been reported. 

Synergists. — Alcohol, ether, nitrous oxide, the mydriatics — bella- 
donna, hyoscyamus, etc., opium, and the cerebral stimulants generally, 
promote the actions of hemp. 

Physiological Actions. — The resin of hemp is a soft solid; is solu- 
ble in alcohol and in ether, in the- fixed and volatile oils, and in the fats. 



CANNABIS INDICA. 377 

It has a balsamic taste, but is bitter and acrid. It promotes the appe- 
tite and the digestion somewhat. The most important actions are 
those referable to the nervous system. There is a distinction to be 
made between the effects on the nervous system of the inhalation of the 
fumes of hashish and those effects which follow the stomach adminis- 
tration. Inattention to this point has, probably, given rise to most of 
the confusion regarding the physiological actions of this remedy. "When 
inhaled it produces a singular muscular erythism and agitation, a great 
desire for muscular activity and motion, an entire absence of the sense 
of fatigue ; but these sensations are followed by exhaustion, even by 
syncope. Hallucinations occur, but they are not usually agreeable ; 
they are often paiqful, and are replaced by stupor. 

By the stomach, and in moderate doses, hashish is an excitant of 
the nervous system, increasing intellectual and motor activity. In 
large doses, it lowers the tactile sense and the sense of pain — in other 
words, it is analgesic and anaesthetic — and it induces a cataleptic state, 
in which the muscles maintain any position in which they may be 
placed. The mental intoxication is ordinarily of an agreeable kind ; 
the ideas flow more easily, are highly pleasurable, and are usually ac- 
companied by bursts of gay laughter. Not unfrequently the excite- 
ment takes the form of a furious delirium, in which acts of violence are 
committed — whence the name " haschaschins," or assassins, applied to 
the unfortunate hashish-eater who, under the influence of the drug, 
commits murder. It has been maintained, and probably rightly enough, 
that the form which the delirium takes represents the mental and moral 
condition of the individual in his normal state : those who are amiable 
and gay become more so under the influence of hashish ; and those 
possessed of evil and malignant dispositions enact deeds of violence. 

Under the influence of hashish the knowledge of time is lost ; such 
are the number and variety of the images which occupy the mind, that a 
few minutes appear to be hours, days, or even years. After the effects 
of the drug have passed off, the hashish-eater is usually unconscious of 
the events that have transpired. Sleep or coma, according to the dose, 
ends the effects of the drug. 

Dilatation of the pupil, and disorders of vision, which contribute to 
the hallucinations by the distortion of external objects, are produced by 
hemp. Aphrodisiac effects are said to follow the use of hashish ; but 
impotence, which is common in hashish-eaters, doubtless results from 
the repeated over-stimulation of the sexual organs. 

It is not known by what organs, or in what form, hashish is elimi- 
nated. The effects of a large dose are not entirely expended in twenty- 
four hours, and those who have taken it by way of experiment have 
suffered vertigo, headache, and other cerebral symptoms, for some time 
subsequentby. It does not increase auy of the secretions, except it may 
be the urinary, somewhat; and it does not stimulate into increased ac- 



378 CEREBRAL EXCITANTS. 

tivit} 1 - any organs except the cerebro-spinal and the sexual. The sleep 
or stupor which it produces, and which comes on after the stage of ex- 
citement, is not followed by after nausea and depression, as in the case 
of opium. 

Therapy. — The extract of cannabis Indica enters into the composi- 
tion of chlorodyne, a nostrum which has had a great reputation as an 
anodyne and hypnotic. In cholera morbus and diarrhoea this remedy 
has been used successfully, but we now possess more efficient ones. 

Before the days of anassthesia, and in very remote times, the fumes 
of hashish were employed to stupefy and to render painless surgical 
operations. It was also employed to relieve pain, and as a substitute 
for opium in neuralgia, and as an hypnotic. In migraine it has been 
used with decided success by Seguin, Williams, and others. Good re- 
sults have been obtained from it in epilepsy by Sinkler and others, and 
it deserves further consideration in this disease. In chorea, and in 
delirium tremens, it is strongly urged by De Cavaillon, and in senile 
trembling and paralysis agitans it has afforded relief. About one-half 
of the cases of tetanus, for which hemp was much prescribed a few 
years ago, got well under its use ; but more accurate knowledge of 
the natural history of this disease has shown that many cases tend to 
recovery without the aid of medicines. 

At the present time the therapeutical employment of hemp is almost 
entirely restricted to the treatment of certain uterine maladies. It is 
well established that hemp has the power to promote uterine contrac- 
tions. It cannot initiate them, but increases their energy when action 
has begun. It may be given with ergot. 

In consequence of this power which it possesses to affect the mus- 
cular tissue of organic life, hemp is used successfully in the treatment 
of menorrhagia. It is said to be especially useful in that form of 
menorrhagia which occurs at the climacteric period (Churchill). 

There can be no doubt that cannabis Indica is a useful remedy in 
cases of impotence. It need hardly be stated that it is adapted to the 
functional disorder. It may be advantageously combined with ergot 
and nux-vomica in this malady ; for example : I> . Ext. cannabis Indi- 
cas, gr. x ; ergotin. (aq. ex.), 3ij ; ext. nucis vom., gr. x. Ft. pil. no. xx. 
Sig. One morning and evening. 

This agent has also been used with success in the treatment of 
gonorrhoea. It diminishes the local inflammation, allays chordee, and 
lessens the pain and irritation, with the accompanying restlessness. 

Authorities referred to : 

Bulletin General i>e Therapeutique. Various articles, 1870, "74, '76. 
Fluckiger and Banbury. Pharmacographia, p. 491. 
Seguin, Dr. E. C. New York Medical Record, vol. xii, p. 774. 
Williams, Dr. S. W. London Medical Record, vol. i, p. 407. 



COCA, OR CUCA. 379 

Coca, or Cuca. — The leaves of Erythroxylon Coca (unofficial). 

PREPARATIONS. — Infusion ; fluid extract. The fluid extract is the 
most eligible preparation, if carefully prepared. The dose of the fluid 
extract for an adult is 3 ss — 3 ij. 

Composition. — The effects of coca, or cuca, depend on the presence 
of a peculiar alkaloid — cocaine. It contains also an aromatic oil which 
gives it the special aroma and taste, and it possesses considerable as- 
tringency, due to the presence of a tannic acid. The odor, taste, and 
appearance of the infusion, are comparable to those of tea. Cocaine 
has decided basic properties, and combines with acids to form salts. 
It crystallizes in prisms in the smaller rhombic system (Husemann), 
which, when pure, are transparent and colorless. It is very slightly 
soluble in water and in alcohol, but dissolves freely in ether. It has 
a bitter taste, and the salts are more bitter than the alkaloid itself. 

Antagonists and Incompatibles. — The actions of coca are op- 
posed by all those agents which increase waste. The infusion and fluid 
extract are incompatible with the metallic salts. Muriatic acid splits 
cocaine into benzoic acid, and an alkaloid — ecgonin ; hence the mineral 
acids should not be prescribed with the infusion and fluid extract. 

Synergists. — The agents promoting constructive metamorphosis, 
caffein, the cerebral stimulants, and the narcotics generally, increase 
the effects of coca. 

Physiological Actions. — The historical notes of Sir R. Christison 
show that the peculiar properties of cuca-leaves have long been known 
to the inhabitants of Peru. The leaves have a strong, tea-like odor, 
and the infusion resembles ordinary tea in taste. The volatile oil and 
the active principle are readily diffusible, and enter the blood with 
facility. A momentary depression of the pulse and diminution of the 
blood-pressure take place, but these effects are quickly overcome, and 
a considerable increase in the action of the heart, and of the blood- 
pressure, follows (Ott). A feeling- of contentment and of well-being 
takes possession of the mind, the sense of fatigue is removed, drowsi- 
ness is experienced for a brief period, but it is soon succeeded by wake- 
fulness, and increased mental activity. It has long been known to the 
mountaineers of the Peruvian Andes that chewing cuca-leaves in- 
creases the respiratory power, and removes, or lessens, the sense of 
fatigue. The celebrated pedestrian, Weston, having learned this fact, 
was detected in the use of cuca during one of his extraordinary feats 
in London (Thompson). 

As respects the action of cocaine on the nervous system, it has been 
demonstrated that it diminishes the excitability of the motor nerves, 
and impairs the power of voluntary coordination. Its influence on the 
sensory nerves depends on the quantity of the drug ingested ; a small 
quantity increases the excitability of the sensory nerves, whereas a 
large quantity causes paralysis (Ott). It is not known whether or not 



380 CEREBRAL EXCITANTS. 

the paralysis is the result of over-stimulation, and an exhaustion of the 
sensibility. The posterior columns of the spinal cord are chiefly affected. 
The paralysis of the heart which ensues from a large quantity seems 
to be due to an action on the intra-muscular ganglia of this organ. 
It first excites, then paralyzes, the respiratory centre. 

The most interesting question connected with the action of cuca is 
its influence over the metamorphosis of tissue. It certainly lessens 
urea-elimination. As is the case with coffee and tea, cuca acts as an 
indirect nutrient, by checking waste, and hence a less amount of food 
is found necessary to maintain the bodily functions. It is probable 
that some of the constituents of cuca are utilized in the economy as 
food, and that the retardation of tissue-waste is not the sole reason why 
work may be done by its use which cannot be done by the same per- 
son without it. 

Therapy. — Although cuca possesses valuable powers as a restora- 
tive, but little use has been made of it, except by the French. It will, 
no doubt, be found useful in phthisis, and wasting diseases generally, 
and in convalescence from acute maladies. It is a valuable remedy in 
the nervous form of sick-headache, migraine. 

Authorities referred to : 

Bouchardat, Prof. Annuaire de Therapeutique, 1876. 

Christison, Sir Robert. The British Medical Journal, April 29, 18*76. 

Husemann, Drs. Atjgust und Theodor. Die Pflanzenstoffe, p. 89. 

Ott, Dr. Isaac. Cocain, Veratria, and Gelsemia. Philadelphia : Lindsay & Blakis- 
ton, 1874. 

Thompson, Mr. J. Ashburton. The British Medical Journal, March 11, 1876, and 
March 18, 1876. _ 

Caffeiil. — An alkaloid, found in the Caffea Arabica. 

Preparations. — Citrate of caffein. Dose, gr. j — grs. v. 

Properties. — Caffein crystallizes in needle-shaped crj-stals, and in 
prisms, the form depending on the mode of evaporating a concentrated 
solution. It has a bitter and disagreeable taste, and is soluble in water, 
alcohol, and ether. As regards composition, caffein is remarkable for 
the quantity of nitrogen which it contains, surpassing in this respect 
almost all the alkaloids. In the coffee-bean, caffein exists in combina- 
tion with a peculiar acid, caffeic, and with caffeo-tannic acid. 

Antagonists and Incompatibles. — Tannic acid, iodide of potas- 
sium, and the salts of mercury, precipitate caffein from its solution in 
water. Physiologically, it is antagonized by opium (Bennett). 

Synergists. — The actions of caffein are promoted by the agents of 
this group, and by the mydriatics. 

Physiological Actions. — The effects of coffee as a beverage have 
been sufficiently discussed elsewhere. 

Caffein, in small medicinal doses, promotes appetite, increases the 



CAFFEIN. 381 

digestive power by stimulation of the gastric glands, and relaxes the 
bowels slightly. On the heart it exerts at first a decided stimulant 
action, and raises the arterial tension ; but these effects are succeeded 
by weakened cardiac movements and diminished blood-pressure, the 
eardiac muscle and its contained ganglia being both probably paralyzed 
by it. Respiration ceases before the heart stops in animals poisoned 
by caffein. 

As regards the cerebral effects, it may be stated that, at first, drowsi- 
ness occurs ; but this is soon followed by wakefulness, excitement, mus- 
cular tremblings confusion of mind, hallucinations, and delirium. The 
cerebral effects terminate in deep sopor, but this is probably the result 
of exhaustion. Rise of temperature, convulsions, general paralysis, 
occur when toxic doses are administered to animals ; but the temper- 
ature declines when paralysis supervenes. 

Caffein, in common with tea, cocoa, cuca, guarana, and other agents 
similarly employed by mankind, possesses the power to check tissue- 
waste, and to lessen the excretion of urea and the nitrogen of the 
fasces. 

Thekaty. — Caffein is a useful stomachic tonic. In convalescence 
from acute maladies, it is in a high degree serviceable, given to pro- 
mote the constructive metamorphosis. Chronic catarrh of the stomach, 
with occasional attacks of migraine, is a combination of maladies in 
which caffein is especially useful. Paullinia, or cuca, may be used in- 
stead of caffein. 

In the diarrhoea of phthisis, in ordinary atonic diarrhoea, in cholera 
infantum, and in cholera morbus, produced by agencies affecting the 
nervous system, the remedies of this group, especially caffein, are often 
extremely useful. When the vital powers are depressed, and when 
there is at the same time an abnormal excretion of urea — a condition of 
things which exists in incipient phthisis, associated with indigestion — 
caffein, cuca, and paullinia, are in a high degree serviceable. They in- 
crease the appetite and the digestive power, and diminish tissue-waste. 

Black coffee, or caffein, increases the action of the heart, and raises 
the arterial tension, and is therefore useful when the circulation is de- 
pressed from various causes. 

The most important use of caffein, at present, is in the treatment of 
headache. It is adapted especially to the relief of migraine, the so- 
called nervous headache, accompanied with, or without, stomach-de- 
rangement. In this disorder we may administer a grain of caffein every 
half-hour, until the headache is relieved ; or the citrate of caffein may 
be given in an effervescent draught. A very elegant preparation is the 
granular, effervescent citrate of caffein. 

Caffeine has proved very useful in cardiac dropsy ; and in renal 
dropsy in inverse ratio to the amount of damage suffered by the kid- 
neys. It may be used with advantage in ascites when any diuretic 



382 CEREBRAL EXCITANTS. 

will prove serviceable. It is variable in its action, and the system 
soon acquires a tolerance of its effects. 

The action of opium is antagonized by caffein ; hence this agent is 
employed in opium narcosis, and in some cases with success. It may 
be injected hypodermically when the patient is unable to swallow ; but 
it cannot take the place of atropia. 

In hypochondriasis, and in simple melancholy, caffein has been 
used with advantage. It may be given to relieve the drowsiness 
which in so many persons comes on after a late dinner. It helps dissi- 
pate the stupor of uraemia. 

Cases of cervico-brachial neuralgia have been relieved by the hypo- 
dermic injection of caffein. 

Guarana. — A preparation of the seeds of paullinia sorbilis. Dose, 
grs. xv — 3 j. 

Composition. — It contains a principle which has been entitled gua- 
ranin, and which subsequent researches have proved to be identical 
with caffein. 

Actions and Uses. — The physiological effects of paullinia are due 
to its alkaloid, chiefly ; and, as this is the same as caffein, the observa- 
tions already made on the latter are equally applicable to the former. 

The special use of paullinia is in the treatment of sick-headache or 
migraine. It is adapted to the so-called nervous form of sick-head- 
ache, and is less efficient when the attacks are due to stomachal trou- 
bles. As it possesses, directly or indirectly, restorative powers, it may 
be employed to promote constructive metamorphosis. Administered 
with this view; it may be given with advantage in the convalescence 
from acute maladies, in incipient phthisis, and in the wasting dis- 
eases generally. 

The most agreeable form in which to administer paullinia is the 
elixir, but, as this preparation varies according to the taste, honesty, 
and skill of the apothecary, the physician needs to be assured of its 
quality before prescribing. 

Authorities referred to: 

Amort, Dr. R. Boston Medical and Surgical Journal, 1868, p. 17. 

Aubert, M. Physiological Action of Caffein. Centralblatt, 1873, p. 124. 

Bennett, Dr. Alexander. Physiological Actions of Theine, Caffeine, Guaranine, 
Cocaine, and Theobromine. Pamphlet, 1873. 

Leven, M. Archiv de Physiologie, 1868, pp. 179 and 470. 

Pratt, Dr. Boston Medical and Surgical Journal, vol. ii., 1868, p. 6. 

Schmiedeburg, Prof. 0. Ueber die Verschiedenheit der Caffeinwirkung an Rana tenu 
poraria L. und Rana Esculenta L., Arch. f. exper. Path. u. Phar., 1874, p. 63. 



ALCOHOL. 383 



REMEDIES WHICH DIMINISH OR SUSPEND THE 
FUNCTIONS OF THE CEREBRUM AFTER A PRE- 
LIMINARY STAGE OF EXCITEMENT. 

To this group belong the so-called narcotics, the anaesthetics, and 
eorae of those usually classed as antispasmodics. They all agree in these 
respects : their effects are expended, chiefly, on the nervous system : 
they first stimulate the functions of the brain, but this stage of excite- 
ment, which ma}' be of shorter or longer duration, is followed by sopor, 
coma, and complete insensibility. 

Alcohol. — Alcohol. "Spirit of the specific gravity 0.835. Alcohol 
is colorless, is wholly vaporizable by heat, and unites in all proportions- 
with water and ether. Diluted with twenty parts of distilled water, it 
should yield little or no foreign odor." 

Alcohol Amylicum. — Amylic alcohol. Fusel oil. 

"A peculiar alcohol, obtained from fermented grain or potatoes, by 
continuing the process of distillation after the ordinary spirit has ceased 
to come over. An oily, nearly colorless liquid, having a strong, offensive 
odor, and an acrid, burning taste. Its specific gravity is 0.818, and its 
boiling-point between 268° and 272°. It is sparingly soluble in water, but 
unites in all proportions with alcohol and ether. It does not take fire 
by contact with flame, and, when dropped on paper, does not leave a 
permanent greasy stain. Exposed to the air in contact with platinum- 
black, it is slowly oxidized and yields valerianic acid." 

Alcohol Dilutum. — Diluted alcohol. Specific gravity, 0.941. Equal 
parts of alcohol and distilled water. 

Alcohol Fortius. — Stronger alcohol. Specific gravity, 0.817. 

Spiritics Frumenti. — Whiskey. " Spirit obtained from fermented 
grain by distillation, and containing from forty-eight to fifty-six percent, 
by volume of absolute alcohol." 

Spiritus Vini Galilei. — Brandy. The spirit obtained from fermented 
grapes by distillation, and containing from forty-eight to fifty-six per 
cent, by volume of absolute alcohol. 

Vinum Portense. — Port wine. 

Yinum JCericum. — Sherry wine. 

Composition. — A large number of bodies have been classed under 
the generic term of alcohols. A list of the most important of these is 
subjoined : 

Metbylic alcohol CH 4 0. 

Ethylic " C 2 H O orCH 4 + (CH 2 ). 

Propylic " C 3 H 6 or CH 4 + 2(CH 2 ). 

Butylic " C 4 H 10 OorCH 4 O + 3(CH !1 ). 

Amylic " C 6 H 12 or CH 4 + 4(CH„). 

Caproic " C 6 H 14 or CH 4 + 5(0^). 



384 CEREBRAL SEDATIVES. 

These alcohols are called " homologous," because they are closely 
related to each other, and differ by the common multiple CH a . Ethylic 
is the common or ordinary alcohol, and amylic is an impurity existing 
in certain alcoholic beverages — for example, whiskey, in which it occurs 
in consequence of the cupidity of distillers in carrying on the process 
after all the ethylic alcohol has distilled over. Absolute alcohol should 
be entirely free from any odor except its native ethereal odor, and no 
products but carbonic acid and water should result from its combustion. 

Whiskey is a solution of alcohol in water (48 to 56 per cent.), but 
contains various odorous principles and ethers which impart to it its 
peculiar physical properties. The best specimens, doubtless, contain 
traces of fusel-oil, and acetic, butyric, and sometimes valerianic acids are 
present in it. The reactions of these acids with the alcohol result in the 
formation of various ethers, and hence old whiskey is more fragrant and 
therefore more highly prized than the recent product of the still. 

Brandy is also a solution of alcohol in water (48 to 56 per cent.). It 
has a wine-like odor, and a hot, astringent taste. It contains a volatile 
oil, an ether pecular to wines (cenanthic ether), coloring-matters, tannic 
acid, aldehyde and acetic ether. The color is usually factitious : in pale 
brandy, the color is derived from the cask; in dark brandy, from caramel. 
Brandy is made artificially from high-wines by the addition of an ether 
(cognac, acetic or nitric), of coloring-matter (burnt sugar), and an astrin- 
gent to give it the necessary roughness of taste (logwood, catechu, etc.). 

Physiological Actions. — Alcohol in prolonged contact with the 
skin, evaporation being prevented, excites a sense of heat and super- 
ficial inflammation. It coagulates albumen and hardens the animal text- 
ures. The epithelium of the mouth is corrugated by it — a result due to 
the abstraction of water and condensation of the albumen. In the 
stomach alcohol causes a sense of warmth, which diffuses over the abdo- 
men, and is quickly followed by a general glow of the body. In mod- 
erate quantity it induces a superficial congestion of the mucous mem- 
brane — a dilatation of the arterioles — and this increased blood-supply 
enables the mucous follicles and the gastric glands to produce a more 
abundant secretion. The increased formation of the stomach-juices is 
doubtless somewhat determined by the stimulation of the mouths of the 
glands, in accordance with a well-known physiological law. The excita- 
tion of the gastric mucous membrane, when habitual, results in impor- 
tant changes ; a gastric catarrh is established, for the mucous follicles, 
under the influence of repeated stimulation, pour forth a pathological 
secretion. The gastric glands at first simply produce an increased 
amount of gastric juice, but abnormal stimulation results in pathological 
changes in this secretion. The increased blood-supply to the mucous 
membrane sets up an irritation of the connective tissue, which undergoes 
hyperplasia ; the proper secreting structure is encroached upon, and 
the glands undergo atrophic changes which result in still more imrjor- 



ALCOHOL. • 385 

tant modifications of the gastric juice. Alcohol also affects directly the 
constitution of the gastric juice by precipitating the pepsin from its solu- 
tion and by arresting the activity of this ferment. 

In small doses, not too frequently repeated, alcohol increases the 
digestive power by stimulating the flow of blood and soliciting a greater 
supply of the stomach-juices. Large doses impair digestion directlj- by 
precipitating the pepsin, an albuminoid ferment. That a small quantity 
does not produce the same results in a comparative degree, is simply 
due to the fact that it is too far diluted, by the quantity of fluid present 
in the stomach, to act on the pepsin. 

The structural alterations induced by the habitual use of alcohol, and 
the action of this agent on the pepsin, seriously impair the digestive 
power. Hence it is that those who are habitual consumers of alcoholic 
fluids suffer from disorders of digestion — gastric catarrh. The abnor- 
mal mucus which is elaborated in great quantity, acts the part of a fer- 
ment, and the starchy, saccharine, and fatty elements of the food undergo 
the acetic, lactic and butyric fermentation. Acidity, heartburn, pyrosis, 
regurgitation of food, and a peculiar retching in the morning (morning 
vomiting of drunkards) are produced. 

As alcohol is a very diffusible substance, it enters the blood with 
great facility, and probably almost all of that taken into the stomach 
passes into the blood from this organ, and does not reach the small 
intestine. The liver is consequently the first organ, after the stomach, 
to be influenced by the ingested alcohol. The blood of the portal vein, 
rendered more highly stimulating by the presence of alcohol, increases 
for the time being the functional activity of the liver-cells, and, as is 
the case with the stomach, a more abundant glandular secretion follows. 
Frequent stimulation and consequent over-action result in impairment 
or loss of the proper function of the part, as is the universal law. The 
hepatic cells, over-stimulated, produce an imperfect product ; they are 
affected by fatty and atrophic changes, and shrink in size ; and the con- 
nective tissue of the liver undergoes hyperplasia. The first result of 
the structural alterations is an increase in the size of the organ ; but 
with the shrinking of the hepatic cells, and the contraction of the newly- 
formed connective tissue, the liver becomes smaller, nodulated, and 
hardened. To this change the term cirrhosis has been applied. It is 
essentially a slowly-developing and chronic malady, and long indulgence 
in alcoholic liquids is necessary to its production. 

In small doses alcohol increases the action of the heart and the 
cutaneous circulation ; a slight general rise of temperature is observed ; 
and all of the functions are, for the time being, more energetically per- 
formed. If a considerable dose be taken, the phenomena of exhilaration, 
of excitement, of slight intoxication ensue. A still larger quantity 
causes loss of muscular power, impaired coordination of voluntary 
movements, and rambling incoherence. When a toxic dose is taken, 
26 



386 CEREBRAL SEDATIVES. 

the stage of excitement is of short duration; profound insensibility, 
with stertorous breathing and complete muscular resolution, quickly 
follow. 

As respects the action of alcohol on the nervous system, it is obvious 
that its first effect is to increase the functional activity of the brain ; the 
ideas flow more easily, the senses are more acute, the muscular move- 
ments are more active. These effects are coincident with the increased 
action of the heart, the slight rise of temperature, and the greater ac- 
tivity of the functions of the organism in general. With the increased 
action of the alcohol on the cerebrum the excitement becomes dis- 
orderly, the ideas incoherent and rambling, the muscular movements 
uncontrolled and incoordinate (over-stimulation of the cells of the 
gray matter). With an excessive quantity, the functions of the cerebrum 
are suspended, and complete unconsciousness ensues ; the reflex move- 
ments cease ; the functions of organic life are performed feebly; and, by 
an extension of the toxic influence to the centres presiding over these 
movements, respiration and circulation finally cease. 

That these effects on the intra-cranial organs are due to the direct 
action of the alcohol has been shown. Alcohol has been discovered in 
the fluid contained in the ventricles, and has been distilled from the 
cerebral matter ; and Hammond has demonstrated that it has a special 
affinity for nervous matter, being found in the cerebro-spinal axis and 
in the nerves, in greater quantity than in other tissues of the body. As 
a result of the direct contact, chiefly, but in part also from the variations 
in the intra-cranial blood-current, important structural alterations are 
gradually wrought in the cerebral matter. The cells of the gray matter 
become more or less fatty and shrunken, the neuroglia undergoes hyper- 
plasia, shrinking and condensation of the whole cerebrum ensue 
(sclerosis), and the cerebro-spinal fluid relatively increases. The ob- 
jective evidences of these pathological changes are seen in the impaired 
mental power, the muscular trembling, the shambling gait, of the 
drunkard. 

In some subjects from sudden excess of a periodical kind, in others, 
from a failure of the stomach to dispose, not only cf aliment, but of the 
accustomed stimulus, a peculiar morbid state, known as delirium tremens, 
is produced. Peculiarity of the nervous system — idiosyncrasy — is an 
important factor in the causation of this condition and probably also 
the use of alcoholic beverages rich in fusel-oil — for Richardson has 
shown, and the author has repeatedly confirmed the observation, that 
amylic alcohol causes tremors and muscular twitching " identical with 
the tremors observed in the human subject during the alcoholic disease 
known as delirium tremens." 

The long-continued action of alcohol on the nervous system pro- 
duces other disorders besides delirium tremens. Hemi-anaesthesia, 
epilepsy, paraplegia, amaurosis, etc., have been observed to result from 



ALCOHOL. 387 

alcoholic excess, and mental alienation, as the asylum statistics prove, 
has in the same agent its most influential cause. 

It is necessary now to consider what becomes of the alcohol after its 
introduction into the human body, and the influence which it exerts, if 
any, in the metamorphosis of tissue. The results of experiment on 
these points have been remarkably contradictory ; and the questions 
involved are by no means settled. It would require a volume to make 
a satisfactory analysis of the various memoirs and papers which have 
been published on the actions of alcohol. The author, therefore, merely 
presents the conclusions to which he himself has come, after a careful 
consideration of all the more important contributions to the literature of 
the subject. 

A small quantity of alcohol, in a subject not accustomed to its use, 
causes, as has been already stated, increased activity in all the bodily 
funotions, and slight elevation of temperature. Habit, as is the case 
with a great many drugs, modifies in a remarkable manner the physio- 
logical activity of alcohol, and hence these results are not perceived in 
the habitual consumers of this substance. Considerable doses of alco- 
hol cause a decline in the temperature of the body, which is even more 
marked in pyrexia than in the normal state. As respects this effect, 
the influence of habit is equally great, for in old topers a decline in 
temperature does not follow the use of alcohol in doses short of lethal. 
In animals the reduction of the body-heat is more marked than in man. 
To what cause is the decline in temperature, produced by alcohol, attrib- 
utable? This is, doubtless, referable to the diminished rate of tissue 
metamorphosis — for it has been ascertained that the excretion both of 
urea and of carbonic acid is lessened by alcohol. The combustion of 
the nitrogen and carbon foods is, therefore, retarded. This action is 
represented, objectively, by an increase in the body-weight and the 
embonpoint of those who take stimulants moderately. 

The disposition of alcohol in the organism is a subject which has 
gone through several revolutions of opinion. At present the weight of 
authority and the deductions of experiment are in favor of that view 
which maintains that, within certain limits (one ounce to one and a half 
ounce of absolute alcohol to a healthy man), alcohol is oxidized and 
destroyed in the organism, and yields up force which is applied as 
nervous, muscular, and gland force. The amount of alcohol ingested, in 
excess of this oxidizing power of the organism, is eliminated as alcohol 
by the various channels of excretion — by the lungs, skin, kidneys, etc. 
As alcohol checks tissue metamorphosis, and thus diminishes the evo- 
lution of heat and force, it might be expected that the products of its 
own oxidation would supply the deficiency, but this is not the case. 
Alcohol is a useful food in the small quantity which increases but does 
not impair digestion, which quickens the circulation and gland secretion 
but does not over-stimulate, and which is within the limit of the power 



388 CEREBRAL SEDATIVES. 

of the organism to dispose of by the oxidation processes. This amount 
has been pretty accurately shown, as stated above, to be one ounce to 
one ounce and a half of absolute alcohol for a healthy adult in twenty- 
four hours. All excess is injurious. North-pole voyages, military ex- 
peditions (experiences in India and the Ashantee march), and the 
diminished power of resistance to cold shown by drunkards, have con- 
clusively demonstrated that alcohol does not supply the place of other 
foods ; and that those habituated to its use, damaged as they are in their 
vital organs, do not possess the same endurance of fatigue and the same 
power of resistance to external morbific influences as do the healthy. 
Furthermore, clinical experience has amply proved that topers do not 
bear chloroform well, that they succumb more quickly to injuries and 
surgical operations, and that they possess much less power of resistance 
than the temperate to the inroads of acute diseases. While these facts 
rest upon the soundest basis, it is equally true that alcohol is, within 
certain limits, a food, and that the organism may subsist, for a variable 
period, on it exclusively. 

It is an important clinical fact that the physiological effects of alco- 
hol differ in different conditions of the system. In convalescence from 
acute diseases, in the sudden depression of the powers of life caused 
by the bites of venomous snakes, or from loss of blood, or from 
serious injur} - , quantities which would, in the state of health, cause pro- 
found intoxication, are taken with impunity. The extremes of life — in- 
fancy and old age — bear considerable quantities of alcohol well, and are 
often r'emarkabty benefited by them. Habitual use modifies still more 
decidedly the immediate influence of this agent on the functions of 
calorification, of circulation, and of the nervous system. 
| The differential diagnosis of acute alcoholism (lethal dose), of opium 
narcosis, concussion of the brain, cerebral haemorrhage, and haemorrhage 
into the pons or medulla, is by no means easy. In the absence of the 
history, in any given case, it may be impossible to determine. The odor 
of the breath (of opium or alcohol) ; the state of the pupil (contract- 
ed from opium, unequal, or contracted or dilated from intra-cranial 
haemorrhage, contracted or dilated from alcoholic intoxication) ; the 
muscular resolution (common to all these states) ; the slow, sighing, 
irregular, or stertorous respiration (may occur in either) ; the abolition 
of reflex movements (a final symptom in all), are in the nature of things 
fallacious. A man who has received a concussion of the brain, or had 
an intra-cranial haemorrhage, may have taken opium or alcoholic stimu- 
lants in quantity sufficient to impart a distinct odor to his breath, with- 
out otherwise being distinctly affected by it. The other signs are not 
sufficient in themselves to enable a decision to be reached. Hence the 
importance of an attentive examination of the surrounding circum- 
stances. In the absence of a trustworthy history, suspend opinion until 
the further developments of the case enable an exact diagnosis to be 



ALCoeoL. 889 

made. The numerous examples of errors fallen into by most competent 
observers should make the physician hesitate before pronouncing an 
opinion of " drunk " or " dying," in the sensational language by which 
some of these cases of mistake have been characterized. 

The treatment of acute alcoholism consists in the evacuation of the 
stomach by the stomach-pump of any unabsorbed alcohol ; the cautious 
inhalation of ammoniacal gas ; cold affusion to the head ; faradisim of the 
muscles of respiration, external warmth, etc. 

As respects the post-mortem appearances the following have been 
observed : intense hyperaemia of the gastric mucous membrane ; disten- 
tion of the right cavities of the heart, and of the great venous trunks ; 
hyperasmia of the cerebral meninges, and serous effusion into the ven- 
tricles and subarachnoid spaces. 

Therapy. — Alcohol in small doses is a useful stomachic tonic. It is 
best taken for this purpose after or with meals. It is specially service- 
able in the feeble digestion of old people, the atonic dyspepsia of the 
sedentary, and in the slow and inefficient digestion of convalescence 
from acute diseases. It should be prescribed with caution in these cases, 
especially in the atonic dyspepsia of women and of sedentary men, 
because of the danger that an alcohol habit may be formed. When it is 
prescribed in the convalescence of acute diseases, the stimulant should 
be withdrawn at the earliest period. 

Excellent results are obtained from the use of brandy in the apepsia 
of infants. The summer diarrhoea, both of children and adults, may be 
arrested by a full dose of brandy. Irritating matters and undigested 
food should be removed before the brandy is administered. The vom- 
iting of cholera-morbus and of cholera may, frequently, be arrested by 
small doses of iced brandy (a teaspoonful in pounded ice every half- 
hour), or tablespoonful doses of iced champagne. Other forms of vom- 
iting, when due to irritation or inflammation of the stomach — as, for 
example, the vomiting of pregnancy — can sometimes be promptly cured 
by the same remedy. It sometimes happens that, in delirium tremens, 
nothing is retained by the stomach, and the life of the patient is put 
into imminent danger, by reason of the failure of the food-supply to the 
blood. A little brandy and ice will sometimes settle the stomach under 
these circumstances, and enable the patient to take and digest the much- 
needed aliment. 

Notwithstanding the theoretical objections which may be urged 
against this practice, clinical experience is strongly in favor of the use of 
alcoholic stimulants to counteract the depressing influence of certain 
agents on the action of the heart — as, for example, aconite, veratrum 
viride, conium, digitalis, and the poison of venomous snakes. Before 
commencing the inhalation of chloroform, an ounce or two of whiskey or 
brandy should be given the patient. This serves a double purpose : it 
sustains the heart and prolongs the chloroform narcosis. 



390 CEREBRAL SEDATIVES. 

Alcohol in some form is constantly prescribed in low conditions in 
fevers, acute inflammations, and depressing maladies of all kinds. It 
is serviceable in these diseases, when it lessens the pulse-rate, but in- 
creases the contractile power of the heart and elevates the arterial ten- 
sion. It does harm when the pulse becomes more rapid and the blood- 
pressure is lowered by it. It does good when the tongue, before dry, 
becomes moister under its use, and harm when the dryness of the 
tongue is increased. It does good when the temperature is reduced, the 
delirium and subsultus lessened, and the sleep becomes more continuous 
and refreshing ; and does harm when it increases fever, exaggerates the 
delirium, and induces coma vigil. The chief utility of alcohol in these 
forms of disease is not as a stimulant, but as a food. It furnishes 
material, easily oxidizable, which can be applied as nervous, muscular, 
and gland force. Furthermore it stimulates digestion, and enables more 
food to be taken and disposed of, and thus contributes indirectly to the 
maintenance of the powers of life. It follows from these considerations, 
that alcohol should be given in these low conditions of the organism, 
with milk, eggs, broth, and other suitable aliment. 

Undoubtedly the stimulant treatment of adynamic states is often car- 
ried to great excess. The large doses of alcoholic substances adminis- 
tered, disorder the stomach and suspend digestion ; and thus the condi- 
tion of things which they are intended to relieve is only made worse. 
Furthermore, stimulants are excessively used in these disorders, from a 
wrong notion of their therapeutic action, and a conviction that diseases 
characterized by depression are best treated by arterial stimulants. The 
reaction which has set in against the antiphlogistic methods is in part 
answerable for the great freedom with which alcohol is now used in 
fevers and inflammations. 

•As respects its action on the nervous system, alcohol is a narcotic. 
It may be used to relieve pain, to promote sleep, and to quiet delirium. 
The various neuralgice may be temporarily alleviated by intoxicating 
doses of alcohol, but such a prescription is dangerous to the moral health 
of the patient. The subjects of neuralgia, or those who possess the neu- 
rotic temperament, have as a rule an inherited or acquired weakness of 
constitution, and a mobility of the nervous system, which render the 
effects of alcoholic stimulants peculiarly grateful. 

When wakefulness is due to a condition of cerebral ancemia, a full 
dose of some alcoholic fluid, whiskey or brandy, will procure sound and 
refreshing sleep. In some subjects a glass of ale or beer answers better. 
Some cases of delirium tremens are greatly benefited by alcoholic stimu- 
lants. When the delirium is the result of sudden excess and of the 
direct action of the alcohol on the cells of the gray matter, the use of 
this agent will only add to the existing disorder ; but when, as is so fre- 
quently the case, the attack is determined by the failure of the stomach 
to appropriate not only the stimulant but the food also, the careful 



ALCOHOL. 391 

administration of alcoholic stimulants with suitable aliment renders an 
incontestable service. 

As alcohol stops waste, promotes constructive metamorphosis by 
increasing the appetite and the digestive power, and favors the depo- 
sition of fat, it is directly indicated in chronic wasting diseases, espe- 
cially in phthisis. Clinical experience is in accord with physiological 
data : alcohol is an important remedy in the various forms of pulmo- 
nary phthisis. It is frequently given with cod-liver oil, or an ounce or 
two of whiskey may be taken with some bitter or aromatic immediately 
after meals. It is an interesting fact that an intractable form of phthisis 
is induced by alcoholic excess. If alcohol disagrees, if it does not im- 
prove but lessens the appetite, it will do harm in phthisis. 

External Applications of Alcohol. — Equal parts of alcohol and 
water is an excellent evaporating lotion for the relief of superficial in- 
flammations — bruises, inflamed joints, orchitis, etc. Alcohol is an ex- 
cellent haemostatic, for restraining oozing from a large surface. For 
suppurating wounds alcohol is an excellent antiseptic dressing — it 
destroys germs, removes fetor, and stimulates the tissues to more 
healthy growth. It favors the cicatrization of open wounds by coagu- 
lating the albumen and thus making an impermeable covering. It is 
a useful practice to wash the parts threatened with bed-sores with 
whiskey or alcohol ; it hardens the cuticle, and prevents ulceration. 
Sore nipples may be prevented by washing them with brandy after the 
child nurses, and then dusting them with bismuth carbonate. Brandy- 
and-water is an excellent lotion for mercurial and other forms of sto- 
matitis, requiring stimulant applications. Brandy-and-water is one of 
the thousand injections used in gonorrhoea. . 

Authorities referred to : 

Axstie, Dr. Francis E. Stimulants and Narcotics, and various papers in The Prac- 
titioner. 

Binz, Prof. Dr. C. Virckoio's Archiv, vol. li., p. 153. 

Ibid. The Practitioner, vol. iii., 1869, and vol v., 18 70. 

Dcpre, A., Ph. D. The Practitioner, vol. viii., pp. 14S, 224. The Elimination of 
Alcohol. 

Jones, Dr. C. Handfield. The Practitioner, vol. vii., p. 331. 

Lallemand, Perrix et Dcroy. Du Pole de VAlcoblet des Anmsthetiques dans V Or- 
ganisme, Paris, 1860. 

Lombard, Dr. J. S. Neva York Medical Journal, June, 1865. 

Murchison, Dr. Charles. A Treatise on Fevers, second edition, p. 230. 

Nicol, Dr. Patrick. The British and Foreign Medico-Chirurgical Bevieic, vol. 1., 
p. 203. 

Parkes, Dr. E. A. and Count Cir. TVollovticz. Experiments on the Effects of Alcohol 
(ethyl alcohol) on the Human Body. 

Rabow, Dr. S. Berliner klinische Woclienschrift. Beobachtungen ubcr die Wirkung 
des Alkohol auf die Kbrpertemperatur, 1871, p. 257, el seq. 

Richardson, Dr. B. W. The Medical Times and Gazette, December 18, 1869, p. 703 

RiNdER and Rikard. The Lancet, August 26, 1866, p. 208. 



392 CEREBRAL SEDATIVES. 

Vinum. — Wine. 

Vinum Portense. — Port wine. 

Vinum IKericurn. — Sherry wine. 

These are the only wines recognized by the United States Pharma- 
copoeia. In medical practice a great variety are employed, in accord- 
ance with special indications. It would occupy too much space, and be 
foreign to the purpose of this work, to enter into details in regard to 
particular wines, but some attention should be given to the different 
groups. 

Sparkling Wines. (Champagne, sparkling catawba, etc.) — : These 
are wines which have been bottled before the stage of fermentation has 
been completed, hence they are lively, or sparkling, in consequence 
of being charged with carbonic acid. A considerable portion of the 
grape-sugar has not been converted into alcohol; they are sweet wines, 
therefore, and the quantity of absolute alcohol which they contain is 
relatively low (eight to twelve per cent.). Sparkling hock is a lighter 
wine than champagne, and contains less sugar. Sparkling catawba 
more nearly resembles hock than champagne. 

A sophistication now much practised consists in adding to still wines 
carbonic-acid gas, by pressure, in the same manner that carbonic-acid 
water is manufactured. 

Dry Acid Wines. — The best specimens of this group are the Ger- 
man Rhine and Moselle wines, California hock, and Ohio and Kelly- 
Island catawba. The German varieties are very numerous, and are 
remarkable for their flavor, for the completeness of the fermentation 
(absence of sugar), and for their permanence. The most important of 
the varieties are the following : Diirkheimer, Ungsteiner, Hochheimer, 
Deidesheimer, FOrster, Rudesheimer, Johannisberger, Liebfrauenmilch, 
etc. The French wines are, as a rule, rather acid. The best known 
are the clarets, but these are more properly classed with the red 
wines. 

Sweet Wines. — In this group are contained Burgundy, still cham- 
pagne, muscatel, malaga, Hungarian Tokay, and angelica, Madeira, 
etc. The alcoholic strength of these wines, unless fortified, is rela- 
tively low, because the sugar has not been consumed by the fermen- 
tation. 

Light Red Wines. — The French clarets, the red Rhine wines, the 
American Ives's seedling, and Concord and Hungarian, are members of 
this group. They contain a large proportion of the coloring-matter of 
the grape, and considerable tannic acid. 

• 
Note. — Among the best wines for medicinal use are the Hungarian wines of Mr. L. 
Reich, of New York. The Tokay has fine bouquet and flavor and good body, and the red 
wine is a claret of excellent quality. These wines are to be commended because they 
present satisfactory evidence of being the product of the fermentation of pure grape- 
juice. 



WINE. 393 

Heavy Red Wines. — Port is the principal representative of this 
group, hut it is not a natural wine ; during the process of manufacture 
spirit is added, and its alcoholic strengtli is raised to thirty or forty per 
cent. California port when fortified, as it probably frequently is, should 
be classed in this division. 

Dry Spirituous Wi?ics. — The most important member of this group 
is sherry. 

Composition and Pkoperttes. — The composition of wine is ex- 
tremely complex. The constituents ascertainable by chemical analysis 
do not represent all of the peculiar qualities which render various wines 
desirable. Bouquet and flavor cannot be determined by the most 
expert chemist, and elude all other means of investigation but the 
tongue and nose of the " wine-taster." 

A wine is a solution of alcohol in water, mixed with various con- 
stituents of the grape. The proportion of alcohol ranges from six to 
forty per cent. — the largest quantity being found in the artificial wines, 
such as port and sherry. The proportion of sugar varies greatly — from 
three to twenty-five per cent. The acids are fixed (tartaric) and volatile 
(acetic). The relation between these several constituents is nearly as 
follows: Port contains about fifty-three parts by weight of alcohol to 
one part of acid, and twelve parts of sugar to one part of acid. The 
average of sherry is thirty-nine of alcohol and 1.5 of sugar to one 
of acid. In the sweet wines, the average is about thirty parts of sugar 
to one part of acid and fifteen parts of alcohol. In the acid wines, 
the average proportion of alcohol to acid is as eighteen to one, while 
the sugar is almost absent, and in some of the best is entirely so. 
Those are dry wines which are free from sugar. Besides tartaric and 
acetic acids, wines contain, in much smaller quantity, malic, tannic and 
carbonic acids. Wines containing less than three hundred grains of 
acid to the gallon are wanting in flavor ; on the other hand, an excess 
of acid over five hundred grains to the gallon is too sour to be agree- 
able. The coloring-matter of wine varies greatly, and the distinction 
between " white " and " red " depends on the quantity present in these 
different varieties. The red wines are more astringent, due to the larger 
proportion of tannin w T hich they contain, and they are also rougher to 
the taste. 

Wine contains a great many mineral constituents : tartrates of po- 
tassa and lime, chlorides of sodium, potassium and calcium, and sul- 
phates of potassa and lime. The percentage of ash ranges from 0.18 
to 0.40. 

The peculiar odor of wine (bouquet) is due to cenanthic acid, and 
cenanthic ether, produced by a reaction of the acid on the alcohol. 

According to Fresenius, the quality of a wine is so much the better 
the less it contains of free acid, the more it contains of sugar, and 
the greater its quantity of extract y and, further, its quality is not de- 



394 CEREBRAL SEDATIVES. 

cidedly influenced by the quantity of alcohol, and cannot be determined 
by its specific gravity. 

A certain quantity of free acid is necessary, but it should not be 
greater than can be masked by the alcohol, sugar, and extractive matter. 
The flavor and odor of wine are produced by ethers formed by the action 
of the free acid on the alcohol ; hence the importance of this acid con- 
stituent. 

Dr. Druitt, in his " Report on Cheap Wines," has very well summed 
up the qualities of good wine, in the following conclusions : 

" 1. The wine should have an absolute unity, or taste as one whole. 

" 2. Wine should contain a certain amount of alcohol. 

" 3. Wine should be slightly sour. 

" 4. Sweetness is characteristic of a certain class of wines, while cer- 
tain other wines are dry, or free from sugar. 

" 5. Wines should have a taste free from mawkishuess, and indica- 
tive of instability. 

" 6. Roughness or astringency is a most important property, and be- 
longs to most red wines. In moderation it is relished, as sourness is, by 
a healthy, manly palate, just as the cold souse is welcome to the skin. 
In excess it leaves a permanent harshness on the tongue. 

" 7. The wine must have body. This is the impression produced by 
the totality of the soluble constituents of wine — the extractive, that 
which gives taste to the tongue, and which, as wine grows older, is de- 
posited along with the cream of tartar forming the crust. 

" 8. JBouquet is that quality of wine which salutes the nose. Flavor 
is that part of the aromatic constituent which gratifies the throat. 

" 9. The wine must satisfy. A man must feel that he has taken some- 
thing which consoles and sustains. Some liquids, as cider and thin 
wines, leave rather a craving, empty, hungry feeling after them." 

Physiological Actions. — As respects the alcohol which they con- 
tain, the physiological actions of wines could be discussed with the 
previous article. But wines differ from alcohol, and from brandy and 
whiskey, not only in spirituous strength, but in the possession of the 
varied and important constituents mentioned above. 

The sparkling wines are more sedative to the stomach, and are more 
intoxicating, relatively to their alcoholic strength, than the other wines. 
As they contain a considerable quantity of unappropriated sugar, acid 
fermentation is apt to occur, and acidity, with headache, follows their 
use. As respects the influence on the pulse, they are less stimula- 
ting than the stronger wines, and the experiments of Dr. Edward 
Smith have demonstrated that they increase the excretion of carbonic 
acid. 

The dry acid wines are more purely stimulant, partly in consequence 
of their alcohol, and partly in consequence of the important ethers which 
they contain. As they are free from sugar, acid fermentation does not 



WINE. 395 

follow their use, but with some subjects the free acid present in them 
disagrees. 

The sweet wines have, generally, considerable body and alcoholic 
strength. They rather pall on the appetite ; are apt to disorder the 
stomach, and produce headache. Some of them have fine bouquet and 
flavor, and are satisfying to the palate; but as a rule they are not borne 
as well as the dry wines. 

The red wines, light and dark, are astringent and have considerable 
body and alcoholic strength. The tannin which they contain, and color- 
ing-matters, are apt to cause stomach-disorders, constipation, and a 
febrile state. By reason of the large amount of alcohol in them, espe- 
cially in port, they approach whiskey and brandy in power as stimulants 
and narcotics. 

Therapy. — The effervescing or sparkling wines often render impor- 
tant service in irritable states of the stomach without inflammatory ac- 
tion. The vomiting of pregnancy, of sea-sickness, of yellow fever, of 
choleramorbus, with depression, and of true cholera, are not infrequently 
arrested by tablespoonful-doses of iced champagne every fifteen minutes. 

A generous glass of a dry wine (sherry) taken with the principal meal 
greatly assists the digestion of the sedentary who suffer from atonic 
dyspepsia.. The wine should be taken during the course of the meal, 
and at no other time. Persons who suffer from acidity, due to an excess 
of formation of acid gastric juice, are relieved by a dry acid wine, taken 
during the meal or just previously. For this purpose a genuine Rhine 
wine — for example, Forster Riesling — is best. 

In diarrhoea and dysentery, after the acuter symptoms have subsided, 
and when there is considerable depression, those wines are indicated 
which contain tannin — the red wines, claret, Ives's seedling, port, etc. 

In cases of anmmia and chlorosis, wines render an important ser- 
vice by increasing digestion and assimilation. To aid in this process, 
red wines with a good deal of sugar and extractives are most necessary. 
When wines produce headache, and the digestion is disordered by them, 
and the appetite impaired, they are not serviceable in these maladies. 
Moreover, for the nervous and hypochondriacal, wines must be pre- 
scribed with caution, for the habit of indulgence is quickly acquired by 
such subjects. In convalescence from acute diseases, there can be no 
difference of opinion as to the great value of wine as a restorative. 
Wines of considerable body and alcoholic strength are indicated under 
these circumstances. When there is much nervous restlessness, wake- 
fulness, and cardiac depression, a wine rich in ethers is specially useful, 
according to Anstie. In chronic wasting diseases, as phthisis, scrofula, 
etc., the stronger wines, as sherry, burgundy, port, may take the place, 
in some cases, of the spirits, whiskey, and brandy. In these wasting 
diseases, wines serve a double purpose : they stimulate the activity of 
the primary assimilation, and within certain limits they are utilized as 



396 CEREBRAL SEDATIVES. 

foods. They are only harmful when digestion is impaired by them ; and 
under no circumstances can they take the place of other aliment. 

In passive haemorrhages, in the hemorrhagic diathesis and in pur- 
pura, wines are indicated, because they elevate the arterial tension, and 
thus act indirectly as haemostatics. 

In various acute diseases, when the action of the heart becomes feeble 
and irregular, the pulse dicrotic, and there occur wakefulness aud de- 
lirium, a wine of considerable alcoholic strength and rich in ethers is 
peculiarly serviceable. Wines are much more largely used in fevers 
(typhoid, typhus, etc.) than in any other forms of disease, and the cir- 
cumstances requiring their employment are indicated in the preceding 
sentence. The routine practice of alcoholic stimulation in fevers cannot 
be justified. Exact indications for the use of wine exist in the state of 
the heart and arterial system, and of the brain, and these should be 
sought for in every case, instead of prescribing for the name. In fevers, 
wines precede the spirituous liquors. The first weakening of the heart's 
action, the beginning of dicrotism, and the transitory delirium and sub- 
sultus, require champagne and the light and acid wines ; more profound 
adynamia, with diarrhoea, the stronger red wines. 

In acute inflammations (pneumonia, pleuritis, peritonitis, etc.), 
wines serve to maintain the strength when the powers of life are weak- 
ening, or to maintain the functions of brain and heart when crises occur, 
as in pneumonia. The rules for the administration of wine in acute in- 
flammations are the same as in fevers. 

Next to their use in fevers, wines are most frequently prescribed, 
and with the greatest advantage, in surgical practice, for the conse- 
quences of wounds and injuries, to support the powers of life under pro- 
tracted and prof use suppuration, and to favor digestion and assimilation 
in the course of convalescence from surgical diseases. 

The immediate stimulant effect of wine is of great value in sudden 
and prof use loss of blood, whether from injuries and surgical operations, 
or post partum. A highly-etherized wine of good body is most useful 
here, because it produces a prompt effect and easily yields up the force 
needed to keep the heart and brain in action, and, in the case of the 
relaxed uterus, to furnish the power needed to procure its energetic con- 
traction. 

Beer, Ale, Porter. — Beer and ale are fermented liquors made from 
malted grain, hops and other bitter substances being added. Ale is pro- 
duced by rapid fermentation, in which the yeast rises to the surface, and 
beer is the product of slow fermentation in cool cellars, the yeast falling 
to the bottom. Hence the name lager-bier. Porter embraces the quali- 
ties of beer and ale, and is so named on account of its strong quality, 
which endeared it to porters. 

Composition. — The proportion of alcohol varies somewhat. In Edin- 



MALT LIQUORS. , 397 

burgh ale it amounts to about six per cent.; in brown stout to six per 
cent. ; in porter to four per cent. ; in beer two to three per cent. Besides 
alcohol and water, these malt liquors contain extract of malt five to 
fourteen per cent. ; carbonic acid 0.16 to 0.G0 per cent. In the extract 
are found also various aromatic substances, lactic acid, potash and soda 
salts, etc. 

Physiological Actioxs. — So far as the alcohol is concerned, beer, 
ale, and porter correspond in physiological actions to the spirituous 
liquors and to wines. As they contain malt extract, their nutritive value 
is greater than spirits and wine. An important constituent, the hop, 
being an aromatic bitter, the tonic and stomachic qualities of these malt 
liquors are also greater than their congeners. The process of fermen- 
tation, however, lessens in a remarkable degree the nutritive and sto- 
machic qualities of the constituents which enter into the composition of 
malt liquors. Their value as foods is much exaggerated by the habitual 
consumers. They increase the appetite and favor the deposition of fat. 
Although the malt beverages do not cause to anj-thing like the same 
extent the alterations in the nervous centres produced by the spiritu- 
ous, they induce other and almost as important structural changes. 
They set up in the organism fatty degeneration of various tissues, nota- 
blv of the liver and heart. The habitual beer-consumer is known by 
his obesity, his flushed face, embarrassed breathing, puffy hands, yellow 
conjunctiva, etc. The habitual beer-consumer is usually short-lived, 
and the end is reached by hepatic and cardiac disorders. It is certainly 
true that a moderate amount of beer may be taken daily, for a lifetime, 
without any obvious impairment of the functions ; but excessive use 
produces with great certainty the unfavorable effects above described. 

Therapy. — Beer, ale, and porter, are not usually prescribed in acute 
maladies. They are, however, much and justly esteemed as stomachic 
tonics and restoratives in chronic wasting diseases — for example, in 
convalescence from acute diseases and surgical injuries, in cases of 
profuse and protracted suppuration, prolonged lactation, diseases of 
the joints, scrofula, phthisis, etc. 

The malt liquors are harmful in all stomach-disorders with acidity, and 
in chronic affections of the liver, especially fatty liver. "When these bev- 
erages do not improve the appetite, when they cause a sense of epigas- 
tric oppression, and when they coat the tongue, they are not beneficial. 

When wakefulness is due to cerebral anremia, a glass of beer or 
ale at bedtime will frequently produce satisfactory sleep. Puerperal 
mania, delirium tremens, and acute maniacal delirium, when these 
symptoms coexist with a condition of adynamia, are greatly benefited 
by the liberal use of ale (pale or Edinburgh ale). The effect of this 
remedy is to arouse the appetite, to quiet delirium, and to produce 
sleep. In melancholia, excellent results are often obtained by the use 
of porter with a little tincture of opium. 



398 . CEREBRAL SEDATIVES. 

Extract of Malt. — Under this name, is known a thick, syrupy 
liquid having a golden or yellowish-brown color, a sweetish taste, and 
the odor of malt. If properly prepared, it contains beside the con- 
stituents of barley, the ferment diastase. It is much prescribed for 
its restorative qualities, and as a vehicle for cod-liver oil. It is best 
administered immediately after meals. 

JEther.— Ether. lZther, Fr. ; Aether, Ger. 

A very inflammable liquid, having the specific gravity 0.750. It 
wholly evaporates in the air and does not redden litmus. When shaken 
with an equal bulk of water, it loses from one-fifth to one-fourth of its 
volume. 

JEther Fortior. — Stronger ether. " Stronger ether has a specific 
gravity not exceeding 0.728. It is extremely inflammable and does not 
redden litmus. Shaken with an equal bulk of water, it loses from one- 
tenth to one-eighth of its volume. It boils actively in a test-tube, half 
filled with it and inclosed in the hand, on the addition of small pieces 
of glass. Half a fluid ounce of the liquid, evaporated from a porcelain 
plate by causing it to flow to and fro over the surface, yields a faintly 
aromatic odor as the last portions pass off, and leaves the surface with- 
out taste or smell, but covered with a deposit of moisture." 

Spiritus JEtheris Compositus. — Compound spirit of ether. Hoff- 
man's anodyne. (Ether, alcohol, and ethereal oil.) " A colorless, 
volatile, inflammable liquid, having an aromatic, ethereal odor, and a 
burning, slightly sweetish taste. Its specific gravity is 0.815. It is 
neutral, or but slightly acid to litmus. It gives only a slight cloudi- 
ness with chloride of barium ; but when a fluid ounce of it is evapo- 
rated to drjmess with an excess of this test, it yields a precipitate of 
sulphate of barium, which, when washed and dried, weighs six and- a 
quarter grains. When a few drops are burned on glass or porcelain, 
there is no visible residue, but the surface will have an acid taste and 
reaction. A pint of water, by the admixture of forty drops, is rendered 
slightly opalescent." Dose m. x — 3 j. 

Spiritus JEtheris JVitrosi. — Spirit of nitrous ether. Sweet spirit of 
nitre. " Is a volatile, inflammable liquid of a pale-yellow color, inclin- 
ing slightly to green, having a fragrant, ethereal odor, free from pun- 
gency, and a sharp, burning taste. It slightly reddens litmus, but does 
not cause effervescence when a crystal of bicarbonate of potassium is 
dropped into it. When mixed with half its volume of officinal solution 
of potassa previously diluted with an equal measure of distilled water, 
it assumes a j'ellow color, which slightly deepens, without becoming 
brown, in twelve hours. A portion of the spirit in a test-tube half filled 
with it, plunged into water heated to 145°, and held there until it has 
acquired that temperature, will boil distinctly on the addition of a few 
small pieces of glass. 

" Spirit of nitrous ether has a specific gravity 0.837, and contains five 






ETHER. 399 

per cent, of its peculiar ether. It should not be long kept, as it becomes 
strongly acid by age." Dose, 3 ss — § ss. 

Antagonists and Incompatibles. — Ether dissolves iodine, bromine, 
corrosive sublimate, the volatile and fixed oils, many resins and balsams, 
tannin, caoutchouc, most of the alkaloids, sulphur, and phosphorus — the 
last-named two sparingly. As respects its stimulant and anodyne prop- 
erties, it is antagonized by arterial sedatives, quinia, oxygen, protoxide 
of nitrogen, the tetanizing alkaloids, strychnia, picrotoxine, etc. 

Synergists. — Alcohol and its congeners, chloroform, arterial stimu- 
lants, cerebral stimulants, etc., assist the action of ether. 

Physiological Actions. — The physiological effects of ether when 
inhaled require separate treatment ; hence the subject of anaesthesia by 
vapors will be discussed in a special article. It is now proposed to treat 
of the effects of ether administered by the usual route — the stomach. 

Ether has a taste at first sweetish, but afterward hot and pungent. 
It leaves a cooling sensation in the stomach after the subsidence of the 
burning, and this quickly diffuses over the body. Increased action of 
the heart, flushing of the face, warmth of the surface, with increased 
diaphoresis, follow in a few minutes. The senses are quickly excited, 
the mind becomes more active, ideas flow rapidly, and the cerebral 
phenomena of alcoholic intoxication ensue. These effects are of short 
duration, and a feeling of content, mental calm, and sopor, succeeds to the 
transient excitement. Ether is eliminated rapidly, chiefly by the lungs, 
and the whole duration of the effects of even a large quantity ( 3 ij) does 
not exceed an hour. 

Therapy. — Before it is administered, ether should be diluted with 
alcohol, which renders it readily miscible with water. 

A few drops of Hoffman's anodyne (m. x — m. xx) in some camphor- 
water is an excellent remedy to expel flatus from the stomach. Gas- 
tralgia may often be quickly relieved by the same means. A few drops 
of ether, added to cod -liver oil, enable the stomach to bear it more 
easily, and, it is said, favors its digestion ; that it accomplishes this ob- 
ject by increasing the pancreatic juice, is the observation of Claude 
Bernard. Paroxysms of hepatic colic are sometimes treated by the 
internal administration of ether, but this treatment is by no means equal 
in effectiveness to the inhalation of the vapor. Ether mixed with tur- 
pentine has the power to dissolve hepatic calculi, hence the remedy of 
Durande. As Trousseau well remarks, chemical results which take 
place in the laboratory are not reproduced in the body with equal 
facility. The rapidity with which ether diffuses into the blood at the 
temperature of the stomach would appear to preclude the possibility of 
its exerting any solvent action on a calculus fixed in an hepatic duct. 
"Whatever good result is secured by the administration of the remedy 
of Durande must be ascribed to the anodyne and anti-spasmodic action 
of its constituents. 



400 CEREBRAL SEDATIVES. 

Sudden failure of the hearts action (syncope), from mental emo- 
tion or hysteria, is most promptly remedied by the administration of 
Hoffman's anodyne. Mild attacks of angina pectoris, and of spas- 
modic asthma, may sometimes be aborted by a full dose of the ethe- 
real preparations. The subcutaneous injection of ether is very effec- 
tive in sudden cardiac depression. 

Nervous or hysterical sick-headache is quickly cured by 3 ss doses 
of spirit of ether. The most important application of these ethereal 
remedies is in the treatment of the hysterical paroxysm. As the action 
is prompt and quickly expended, it is obvious that ether or Hoffman's 
drops are only adapted to sudden hysterical seizures, and not to more 
lasting nervous symptoms arising in an hysterical constitution. Noth- 
ing can be more satisfactory than the prompt relief by these agents of 
hysterical flatulence, globus hystericus, and hystero-epilepsy. ~fy. Spts. 
etheris composit., tinct. valerian, ammon., aa § j. M. Sig. A tea- 
spoonful in water every fifteen 'minutes until relieved. 

As a cardiac stimulant in fevers, the ethereal preparations are occa- 
sionally prescribed. For a quick effect, in an emergency of practice, 
they are useful, but are not equal to spirits and wine when a sustained 
effect is required. 

Nitrous ether is employed in domestic practice as a mild diapho- 
retic, a diuretic, and carminative. It no longer occupies the place it 
formerly held in medical practice, but it is occasionally prescribed in 
feverishness, as a constituent in expectorant mixtures, in combination 
with diuretic medicines, etc. 

CMoroformum. — Chloroform. Chloroforme, Fr. ; Chloroform, Ger. 

Chloroformum Venale. — Commercial chloroform. " A colorless 
liquid, varying in specific gravity from 1.45 to 1.49. Shaken, with an 
equal volume of officinal sulphuric acid, in a bottle closed with a glass 
stopper, it forms a mixture which separates by rest into two layers ; 
the upper one colorless, and the lower one — consisting of the acid — of 
a brownish hue, which, after the lapse of twenty-four hours, becomes 
darker but never quite black." 

Chloroformum Purificatum. — Purified chloroform. " Purified chlo- 
roform is a colorless, volatile liquid, not inflammable, of a bland, ethereal 
odor, and hot, aromatic, saccharine taste. Its specific gravity is 1.480. 
It boils at 142°. It is slightly soluble in water, and freely so in alcohol 
and ether. When shaken with an equal volume of sulphuric acid, in 
a bottle closed by a glass stopper, and allowed to remain in contact 
twenty-four hours, no color is imparted to either. When one fluid 
drachm is evaporated spontaneously with one drop of a neutral, aqueous 
solution of litmus, the color of the latter is not reddened. The result 
of the test is the same if the chloroform contained in a white-glass hot* 
tie has been previously exposed to direct sunlight for ten hours." 



CHLOROFORM. 401 

Spiritus Chloroformi. — Spirit of chloroform. (Chloroform, 3 j ; di- 
luted alcohol, 5 xij.) Dose, 3 ss — 3 j. 

Antagonists and Incompatibles. — Chloroform separates from the 
mixture when prescribed with weak spirits or glycerine. It is soluble 
in alcohol (ten to six), in ether (one to seven), in water (one to two 
hundred). It dissolves very freely in olive-oil and turpentine, but does 
not dissolve in or mix with glycerine. It has very extensive solvent 
power, dissolving caoutchouc, gutta-percha, mastic, tolu, benzoin, copal, 
among the gums ; iodine, bromine, the organic alkaloids ; fixed and 
volatile oils, resins, and fats. In cases of poisoning by the internal ad- 
ministration of chloroform, the treatment should be conducted on the 
same plan as for irritant poisons. There is no chemical antidote. To 
overcome its effects on the respiratory and circulatory systems, artificial 
respiration, cold affusion, and galvanism, may be employed. 

Synergists. — Anassthetic agents, opium, chloral, alcohol, etc., pro- 
mote the action of chloroform. 

Physiological Actions. — The taste of chloroform is hot, sweetish, 
and pungent. Undiluted it excites violent irritation and inflammation 
of the mucous membrane. In passing through the fauces the vapor 
may enter the larynx in such quantity as to cause great heat and in- 
flammation, followed by oedema. In the stomach, chloroform produces 
a feeling of warmth, followed by coldness, like ether ; but, when taken 
in large quantity undiluted, violent gastritis. Besides the local action, 
chloroform diffuses into the blood, and affects distant parts. Like alco- 
hol and ether, it increases the action of the arterial system, and occa- 
sions excitement of the brain, followed by sopor. In lethal doses pro- 
found stupor and insensibility are produced by it. 

Therapy. — A little chloroform (m. ij — m. v), dropped on sugar and 
swallowed, will remove some kinds of nausea and vomiting. It can be 
useful in non-inflammatory states only, as, for example, sea-siclcness, the 
vomiting of pregnancy, sic7c-headache, etc. Gastralgia may some- 
times be relieved in the same way. The following formula is an effec- 
tive remedy for flatulent colic: I>. Spirit, chloroformi, tinct. cardamomi 
comp., aa 3 ij. M. Sig. A teaspoonful every half-hour in water 
Hepatic and saturnine colic are also benefited by chloroform, but the 
addition of opium increases its efficacy, and is usually necessary in 
these cases. Chloroform is a solvent of biliary calculi, and has been 
prescribed with the view to effect a solution of calculi contained in the 
gall-bladder, or lodged in the hepatic duct. It undoubtedly affords some 
relief, but not probably because of its solvent action. As has been re- 
marked of ether, it is in the highest degree improbable that sufficient 
chloroform, even when it is administered in large doses, can reach the 
calculus to effect its solution, when experiments out of the body have 
shown that some hours are required to dissolve a calculus immersed in 
chloroform. In irritable ulcer of the rectum, and itching about the 
27 



402 CEREBRAL SEDATIVES. 

anal region, an ointment of chloroform gives great relief: ]J. Ung, 
zinoi oxidi, § j ; chloroformi, 3 j. M. ft. ung. The vapor of chloro 
form may be applied directly to these parts. 

In hay-asthma, whooping-cough, spasmodic asthma, irritable reflex 
cough, the vapor of chloroform may be used as follows : To a cup of 
warm water, 80° to 100° Fahr., add a teaspoonful of spiritus chloro- 
formi, and repeat every five minutes. This inhalation should not be 
used except in the presence of a medical man, and not more than five 
teaspoonfuls should be inhaled at a time. The patient should inhale 
the vapors as they arise, directing them into the air-passages from the 
cup by a paper shield. A little chloroform (a minim or two) is a useful 
constituent of expectorant mixtures, when a neurotic element is present. 

Chloroform is a very valuable hypnotic in delirium tremens. It is 
unsafe when used by inhalation in the treatment of this affection, but, 
by the stomach, not unfrequently excellent results are obtained from it. 
It is contraindicated when there are a vigorous action of the heart, and 
an elevated state of the arterial tension, and useful when symptoms of 
depression and adynamia are present. It should be given in the form 
of the spirit. !r>. Spirit, chloroformi, tinct. capsici, aa 3 j. M. Sig. 
A teaspoonful in water every half -hour, hour, or two hours. 

Neuralgia. — Chloroform is extremely valuable in the treatment of 
this disease, and it is the most effective when used by the method of 
" deep injection," first proposed by the author. This plan of treatment 
consists in the injection deeply, in the 'neighborhood of the affected 
nerve, of five to fifteen minims of pure chloroform. The official spirit 
of chloroform, ether, or even alcohol, may be used for this purpose. 
The first named, in the quantity of fifteen minims, is probably the best. 
Rarely does any local mischief result from these injections, except a 
temporary induration. The author has procured by this means appar- 
ently permanent relief to long-standing cases of neuralgic pain (tic- 
douloureux) affecting the superficial divisions of the fifth. Other prac- 
titioners have been equally successful, and the cases thus treated now 
include neuralgic affections of the most important nerves. 

Pain in superficial nerves may sametimes be relieved by the local 
application of chloroform. IJ. Chloroformi, tinct. aconiti rad., aa, 3 ss; 
liniment, saponis, 3 j. M. Sig. Liniment. A piece of flannel, moist- 
ened with this, is applied to the painful part, evaporation being pre- 
vented by a covering of oiled silk. The pain of dysmenorrhoea is 
relieved by the local application of chloroform-vaj^or, and of sciatica, 
lumbago, myalgia, and similar affections, by chloroform applied directly 
to the parts. Nervous headache may sometimes be cured by a little 
chloroform in a watch-glass applied to the temple. 

An impending paroxysm of intermittent may be prevented by a full 
dose of chloroform ( 3 j — 3 ij ) administered before the onset of the 
chill. The inhalation of chloroform is used for the same Durpose. 



CHLOROFORM. 4();> 

A few drops of chloroform, frequently repeated, is an excellent 
means of relief in cholera. It allays nausea and vomiting, arrests diar- 
rhoea, relieves the cramps, and restores the temperature. It may be 
given in the form of spiritus chloroformi, or of chlorodyne, a very cele- 
brated empirical remedy. No single remedy has been more efficacious 
than chloroform in the treatment of true cholera. 

Chloroform as a Counter-irritant. — When chloroform is applied 
to the skin and evaporation prevented, it causes heat, redness, and even 
vesication. Frequently, chloroform is used locally to produce this ef- 
fect, but usually in combination with other counter-irritants. 1J. Chlo- 
roformi, ol. terebinthinae, ail 3 j ; lin. saponis, 3 ij. M. Sig. Lini- 
ment. $. Chloroformi, lin. camphorae, ail 3 j. M. Sig. Liniment. 
These are elegant counter-irritant applications, in cases requiring the 
milder remedies of this class, and are used in various internal inflam- 
mations and local affections characterized by pain. 

Chlorodyne. — This empirical preparation is largely used in cholera, 
and in painful diseases requiring an anodyne. Numerous formulae have 
been published, but none of them appear to possess the exact qualities 
of the original preparation by Dr. J. C. Browne. The dose of the genu- 
ine chlorodyne ranges from ten to thirty drops. The following formula 
makes a product more nearly resembling the original than any other 
known to the author : 

Chloroform 4 ounces. 

Ether ' 1 ounce. 

Alcohol 4 ounces. 

Treacle 4 ounces. 

Extract of liquorice 2 \ ounces. 

Muriate of morphia 8 grains. 

Oil of peppermint 16 minims. 

Sirup 1 *[\ ounces. 

Acid, hydrocyan. dil 2 ounces. 

Dissolve the muriate of morphia and the oil of peppermint in the 
alcohol, mix the chloroform and ether witli this solution, dissolve the 
extract of liquorice in the sirup, and add the treacle ; shake these two 
solutions together, and add the hydrocyanic acid. Dose, five to fifteen 
minims. 

Some of the published formulae contaiu resin of cannabis Indica, atro- 
pia, perchloric acid, in addition to the ingredients above'given. 

The following formulas (Fox) are very efficacious in the local affec- 
tions for which they are recommended: 

I£. Chloroformi, m. vj ; cucumber cerate, 3 j. M. Sig. Ointment 
for pruritus. Tp. Plumbi carbonat., 3ss; chloroformi, in. iv; ung, 
aquae rosae, § j. M. Sig. Ointment for pruritus. IJ. Chloroformi, 
m. viij ; glycerin., 3 j ; ung. simplicis, 3 vj ; potassi cyanidi, grs. iv. 



404 CEREBRAL SEDATIVES. 

M. Sig. Ointment for pruritus. $. Morphiae acetat., 1 part; chlo* 
reform, 8 parts ; lard, CO parts ; oil of sweet almonds, 40 parts. M. 
An ointment to be applied several times a day in pruritus p>udendi. 

Authorities referred to : 

Bartholow, Dr. Roberts. On the Beep Injection of Chloroform for the Relief of Tie- 
Douloureux. The Practitioner, July, 1874, p. 9. 

Gubler, Dr. Adolph. Commentaires Therap. du Codex Medicamentarius, p. 610. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimillellehre, zweiter Band, 
1869. 

Stille, Dr. Alfred. Therapeutics and Mat. Med., fourth edition. 

Trousseau et Pidoux. Traite de Therap. et Mat. Med., eighth edition. 

United States Dispensatory, thirteenth edition. 

ANAESTHETICS AND ANESTHESIA. 

-ffither Fortior. — The stronger ether. 

Chloroformum Purificatum. — Purified chloroform. 

Neither of these anaesthetics should be used until its-conformity to 
the standard of the United States Pharmacopoeia has been ascertained. 
The tests of purity are given under their respective heads in the pre- 
ceding article. . 

The term ancesthetic, proposed by Dr. Oliver Wendell Holmes, means 
an agent capable of producing anaesthesia, or insensibility to pain. It 
is true, anaesthesia is a term which, according to its etymological sig- 
nification, should be applied to loss of sensation of touch, chiefly, and 
analgesia should be used to signify loss of the sense of pain; but the 
word anaesthesia, as expressive of the state of profound unconsciousness 
induced by anaesthetics, is now so firmly established by usage that it 
were better to retain it. Insensibility to pain (analgesia) may be pro- 
duced, without simultaneous loss of common sensation, touch (anaesthe- 
sia). By the inhalation of ether, chloroform, bichloride of methylene, 
nitrous oxide, and some other agents, the functions of animal life can 
be so far suspended that surgical operations involving intense pain, and 
certain natural processes, accompanied by great suffering, can be per- 
formed entirely without the consciousness of the subject concerned. 

Physiological Actions. — When the vapor of ether cr chloroform 
is inhaled, a sense of faucial irritation and of the need of air is expe- 
rienced, and more or less cough is produced. The irritation of the fauces 
excites the flow of mucus, and the reflex act of swallowing. The feel- 
ing of need of air causes the patient to push aside the inhaler or sponge, 
and in children may lead to violent strug-gling. The sensibility of the 
glottis is soon diminished, the coughing ceases, and the inhalation then 
proceeds quietly. 

The first effect is a general exhilaration, the pulse increases in fre- 
quency, the respirations become more rapid, and sometimes assume a 
6obbing or convulsive character; the face flushes; talking, laughing, 



ANESTHETICS. 403 

crying, singing, and sometimes praying, indicate the cerebral intoxica- 
tion. Tins stage of excitement varies in duration iit different individu- 
als, and is more pronounced in character and more persistent in those 
of mercurial disposition, and in the hysterical. At this period, although 
the patient can be easily aroused, sensibility to pain is decidedly dimin- 
ished; although the sense of touch may be preserved, taste and smell 
are abolished, and the sight is either abnormally acute or is perverted 
by illusions. If the inhalation be continued, the patient passes into the 
condition of complete insensibility. In women and children, and males 
reduced by illness, the production of insensibility, if the anaesthetic be 
not inhaled too rapidly, takes place quietly ; but, if the subject be a 
robust male, in full health, especially if the inhalation has been pro- 
ceeded with rapidly, the stage of insensibility is preceded by a tetanic 
convulsive stage, in which the voluntary muscular system and the re- 
spiratory muscles become rigid, the breathing stertorous, the face cya- 
nosed. This condition of rigidity is similar to, if not identical with, the 
tetanic stage of the epileptic paroxysm. If the inhalation of the anaes- 
thetic be pushed still further, the tetanic rigidity subsides, the cyanosis 
disappears, the breathing proceeds quietly, and a condition of complete 
muscular relaxation, and of abolition of reflex movements, is established. 
When this is accomplished the arm drops without resistance when let 
fall, the conjunctiva is insensible to irritation, the pupils do not alter in 
size when exposed to light, and no mechanical irritation awakens the 
least consciousness of pain. The surface is cool, and bathed with abun- 
dant perspiration, the countenance is placid, the eyes closed, the pupils 
rather contracted than dilated ; the respiration easy, but more shallow 
than normal ; the pulse slower — it may be feebler, it may be stronger 
than in health. The functions of the cerebrum are suspended ; only the 
lower centres, presiding over respiration and circulation, continue in 
action. Out of this condition, and without interference, the patient will 
presently emerge. If, however, the inhalation be continued these or- 
ganic functions will be suspended, and life will be terminated by the 
cessation of the action of the heart and of the respiratory organs. 
There are several modes of dying from anaesthetic vapors : 
1. By the first mode, called by Richardson syncopal apnoea, the 
death is sudden and occurs very soon after the inhalation has begun, 
and is ascribed by him to "irritation of the peripheral nervous system, 
accumulation of carbonic acid in the blood, and arrest of the action of 
the heart." This explanation, the author submits with diffidence, seems 
very unsatisfactory, for phenomena of this kind, up to the point of car' 
diac paralysis, must ensue in all cases of chloroform narcosis. The sud- 
den death, at the beginning of inhalation, seems to be more property 
explicable on the theory that the first chloroform vapor which reaches 
fchem paralyzes the cardiac ganglia, already in an abnormal state of 
susceptibility from causes not now understood. 



40G CEREBRAL SEDATIVES. 

2. By the second mode, called by Richardson epileptiform syncope^ 
death ensues in the stage of rigidity preceding complete muscular re- 
luxation, and is due to tetanic fixation of the respiratory muscles, and 
consequent interference with the pulmonary circulation, accumulation 
of blood on the venous side, and arrest of the heart's action. In these 
cases respiration ceases before the pulsations cf the heart cease. 

3. By jiaralysis of the respiratory muscles. Death ensues during 
the stage of complete muscular relaxation, and the action of the heart 
continues for some seconds, or even minutes, after respiration has 
ceased. 

4. By paralysis of the heart. This also occurs in the course of 
complete insensibility; the motor ganglia are paralyzed, and the heart 
suddenly ceases to act, the respiration continuing for a short time 
longer. 

5. This mode of dying is made up of two factors : depression of the 
functions by chloroform narcosis, and the shock of the accident, or the 
surgical operation. Death may ensue during the inhalation, or may 
occur afterward. 

Conditions of the Organism rendering the Use of Anaesthetics 
dangerous. — Experience has demonstrated that old drunkards are 
peculiarly unfavorable subjects. When tumor or abscess of the brain 
exists, it is dangerous to administer anaesthetics. Instances of sudden 
death under these circumstances are relatively numerous. Very much 
enlarged tonsils, swollen epiglottis, oedema of the glottis, are contra- 
indications, but not insuperable, to the use of anaesthetics. Emphysema 
of the lungs is so frequently accompanied by ischsemia of the arterial, 
and engorgement of the venous side of the systemic circulation, and 
with dilatation of the right cavities, that it must be considered a dan- 
gerous state in which to administer chloroform, or even ether. Fatty 
change in the muscular substance of the heart must be considered pecul- 
iarly unfavorable, for more deaths have ensued from this cause than any 
other. 

Chloroform and ether have been administered with safety in cases 
of phthisis and heart-disease (valvular lesions), the muscular substance 
and its contained ganglia being free from structural change. 

Experience has abundantly demonstrated that those reduced by 
illness and disease, and the feeble, bear anaesthetics better than the 
healthy and robust; that children and women are better subjects than 
adults and men ; that anaesthetics are safer when given for operations 
for disease than for injury. 

Incomplete anaesthesia is a condition of danger. Numerous acci- 
dents have occurred from the use of anaesthetics for trivial operations — 
notably for extraction of teeth — in which but a partial degree of insen- 
sibility is induced. In such cases the heart, enfeebled by chloroform 
narcosis, is suddenly paralyzed by the reflex action proceeding from the 



ANAESTHETICS. 407 

peripheral injury. The district of tissue supplied by the fifth nerve is 
an especially dangerous region, owing doubtless to the intimate con- 
nection of the nucleus of the fifth with the nucleus of the pneumogas- 
tric. By far the largest number of fatal cases have resulted from a 
neglect of this rule : it is never safe to proceed in a surgical operation 
with anaesthetics, unless complete insensibility has been produced. 
The author is aware that Trousseau and Pidoux have attributed the 
number of cases cf fatal chloroform narcosis, which have occurred in 
England, to the fact that the just-mentioned rule is adhered to by Eng- 
lish surgeons. Their words are as follows : En Angleterre, les chirur- 
giens portent V Etherisation jusqu'd V abolition de toutes les facultes 
animates, jusqiCau commencement de la periode d , 6the'risme organique. 
Plus prudents sous ce rapport que leurs confreres de la GrandeSre- 
tagne, les chirurgiens franpais ont V habitude de s'arreter des que la 
sensibility aux excitations de la peau est abolie et que la resolution 
musculaire commence. Cette prudence explique comment les chirur- 
giens frangais ont hprouv'e moins d'accidents graves et comptk, moins 
de morts subites. (Vol. ii., p. 322.) 

Modes of conducting the Inhalation. — After ascertaining that 
none of the contraindications mentioned above exist, the patient may 
be prepared for the inhalation of the anaesthetic vapor. The inhalation 
should not be proceeded with soon after a full meal. Vomiting, as the 
narcosis subsides, is usual, and, as the insensibility of the glottis persists 
for some time afterward, particles of food may be lodged in the chink, 
causing fatal suffocation. Several cases of this kind have been imported. 
On the other hand, it is bad practice to administer an anfesthetic after 
a prolonged period of fasting, for the exhaustion thereby induced may 
be an influential factor in determining a fatal result. Before the inha- 
lation is begun, it is proper to administer an ounce or two of whiske} r 
or brandy. Much more important is the expedient proposed by Ber- 
nard and afterward by Nussbaum, to premise a subcutaneous injection 
of morphia. "When this is done a much less quantity of the anaesthetic 
is needed to induce insensibility, and the stage of narcosis is sufficiently 
prolonged for ordinary surgical operations, without requiring renewed 
administration of the ether or chloroform. 

"When the anaesthetic is about to be administered, the operator 
should, by a cheerful and confident manner, remove the fears of the 
patient. None of the paraphema of the operation to he performed 
should be exhibited before the patient, and no remarks should be made 
in his hearing regarding his case, the anaesthetic sleep, or the surgical 
procedure. Only the physician having the administration of the anaes- 
thetic in charge, and the necessary assistants, should be present in the 
apartment. An abundant supply of fresh air should be insured to the 
patient, and all the appliances required for resuscitation should be at 
hand. 



408 CEREBRAL SEDATIVES. 

The simplest apparatus only is required. Complicated inhalers have, 
as frequently as the towel or the handkerchief, been used in fatal cases 
of chloroform narcosis. A cone of stiff paper, lined with lint or felt, and 
large enough to cover the nose and mouth of the patient, is the best 
form of inhaler for the administration of ether. Lente's ether-inhaler con- 
sists of a cone of hard rubber lined with felt, and having attached to the 
apex a flexible rubber tube communicating with the ether-bottle. This 
is a very satisfactory apparatus. When ether is inhaled the atmosphere 
is, as far as possible, excluded, in order that the anaesthetic effect may 
be quickly induced. The important point in the administration of 
chloroform is to secure such an admixture of atmospheric air as that 
the amount of chloroform-vapor shall not exceed three and a half per 
cent. If this rule be regarded, the form of inhaler is cf little impor- 
tance. The original method of Simpson is as good as any : applying 
the vapor by dropping slowly chloroform on a piece of thin cloth laid 
over the mouth and nose, or by a linen handkerchief moistened with 
half a drachm. The mouth and nose should be protected from the irri- 
tant action of the chloroform by inunction with oil. 

In administering the vapor of chloroform by any of the modes in 
use, it should not be forgotten that it has a density and weight four 
times those of air, and that, consequently, when a cloth or handkerchief 
is held closely over the mouth the air is displaced, and the patient may 
be breathing little more than chloroform-vapcr. 

During the administration of ether, attention should be directed to 
the state of the respiration, for arrest of the respiratory movements is 
the only source of danger. When chloroform is being inhaled, the state 
of the circulation, as well as of the respiratory apparatus, must be re- 
garded. 

Means of removing Dangerous Symptoms. — Suspension of the 
heart's action is to be met at once by the withdrawal of the vapor, and 
the inversion of the patient, according to the method of Nelaton ; fail- 
ure of respiration, by forcibly drawing out the tongue, by the practice 
of artificial respiration, and by faradization of the respiratory muscles. 
Artificial warmth should be applied, and cooling of the body by cold- 
water douche, etc., should be prohibited. Acupuncture of the heart, 
galvano-puncture, injection of ammonia into the veins, are measures 
which have been used in extreme cases, but unfortunately rarely witb 
success. 

In practising resuscitation for arrest of breathing due to ether, arti- 
ficial respiration by the method of Silvester, and inversion of the body 
by the method of Nekton, are the most promising expedients. 

Therapy. — Anaesthetic agents are used to quiet pain and spasm 
from disease, to render the dressing of injuries and surgical operations 
painless, and to produce muscular relaxation. Ether-inhalations give 
entire relief to the pain of neuralgia (tic-doidoureux), cancer, and in- 



ANAESTHETICS. 409 

jlummation / to pain dependent on spasms — tetanies, chorea, hepatic 
and nephritic colic, etc. It is not necessary in these cases, as a rule, 
to induce full anaesthesia, for, as has already been pointed out, the 
sensibility to pain ceases before the condition of insensibility is reached 
— before, indeed, the perceptive centres of conscious impressions are 
otherwise impaired than as to the appreciation of pain. Paroxysms of 
maniacal delirium, and of puerperal mania, when violent and uncon- 
trollable, are sometimes quickly quieted and refreshing sleep obtained, 
from which the patient eventually arouses in a calmer frame of mind. 
Ether is the proper agent for this purpose. It should not be forgotten 
that anaisthetics are dangerous in delirium tremens. 

In puerperal convulsions due to reflex irritation, or to uraemia, the 
use of chloroform is iuvaluable. It is equally effective in the reflex con- 
vulsions of early life, in the urcemic convulsions of scarlet fever, and 
in the so-called hystero-epilepsy. When puerperal, or other forms of 
convulsive seizures, are due to cerebral haemorrhage, no good can be 
accomplished by anaesthetic inhalations. In any case, although con- 
vulsions may be arrested by anaesthetic inhalations, other appropriate 
measures must be resorted to for the permanent removal of the causes. 
A paroxysm of epilepsy impending may be aborted by the inhalation 
of ether, but the nitrite of amyl is a more effective remedy for this 
purpose. 

In certain neuroses of the respiratory organs, great relief is ob- 
tained by anaesthetic inhalations. Laryyigismus stridulus may be 
quickly cured by the vapor of chloroform. A few drops of chloroform 
on a handkerchief will suffice, and special care should be taken to dilute 
the vapor largely with air. A similar procedure will relieve severe 
paroxysms of whooping-cough, but a more energetic use of chloroform 
is required when convulsions occur during a fit of coughing. No single 
agent gives more relief in asthma, but, like all other remedies for this 
disease, the power of relief declines, and increasing doses of the anaes- 
thetic become necessary, so that the habit of chloroform or other nar- 
cosis is formed. 

Anmstheiic inhalations should not be recommended in cases which 
will probably require their use for a long time, because the inclination 
for this kind of intoxication grows rapidly, and is as difficult to control 
as the opium-habit. The author has seen one case in which the patient 
consumed a pound of chloroform daily, but, as might be expected, this 
extraordinary consumption of the anaesthetic did not long continue, for 
the patient succumbed in a few months. 

In obstetric practice the applications of anaesthetics are numerous 
and important. The indications and contraindications for chloroform in 
natural labor may be formularized as follows : When the labor is of 
6hort duration, and not excessively painful, anaesthetics should not be 
used ; on the other hand, when the labor is protracted and the suffering 



410 CEREBRAL SEDATIVES. 

great, they favor the progress of the case and prevent exhaustion and 
uterine inertia. In primipara caution is necessary. Tbe inhalation of 
the anaesthetic should not begin until near the close of the first stage, 
unless those painful but ineffectual contractions occur, which have been 
aptly characterized as "nagging pains," when the vapor, very much 
diluted, may be cautiously inhaled for their relief. The inhalation 
should be practised only during the existence of the pain. The influ- 
ence of the anaesthetic on the pulse, respiration, and uterine contrac- 
tions, should be carefully observed, and, if the pulse fail, the respirations 
become shallow, or the pains lose in efficiency, the inhalation should be 
discontinued. If the anaesthetic cause great excitement, and the patient 
become loudly clamorous for more, while the uterine contractions are 
lessening in force, it is doing harm and should be withdrawn. It is 
never necessary, nor proper, to administer the anaesthetic to complete 
unconsciousness. Toward the close of the second stage, when the head 
begins to distend the external parts, the quantity of chloroform may be 
somewhat increased, but the inhalation should be discontinued when 
the occiput has passed under the pubic arch. If these rules are fol- 
lowed, the action of the anaesthetic is beneficent. Properly administered 
the use of chloroform may be considered perfectly safe in the parturient 
female. It is generally conceded that no well-authenticated case of 
death from the use of chloroform in labor has occurred, when the ad- 
ministration was in the hands of a properly-qualified medical man. 

The following evil results, the author believes, have followed the 
incautious use of anaesthetics in labor : the progress of the case arrested, 
so that forceps became necessary; slow and imperfect uterine contrac- 
tion, and consequent postpartum haemorrhage; a toxic condition of the 
mother's blood, with after - excitement, wakefulness, and puerperal 
mania ; asphyxia of the child, tedious convalescence, and subinvolution 
of the womb. 

When instrumental delivery is required, the utility of anaesthetics 
is unquestionably great. It facilitates the necessary manipulations, and 
prevents shock. The inhalation should be carried far enough in these 
cases to produce sufficient quietude in the patient, but not to com- 
plete muscular resolution. When turning is to be performed, the 
state of chloroform narcosis must be deep enough to suspend uterine 
contractions. 

If puerperal convulsions occur at any stage, the utility of chloro- 
form is unquestionable. The limits of its utility in these cases have 
already been indicated. 

When careful examination of the pelvic viscera is to be made to 
establish the diagnosis in difficult and obscure cases, as, for example, 
phantom tumor, ovarian and fibroid growths, pelvic abscess, etc., the 
importance of full anaesthesia can hardly be over-estimated. 

The use of anaesthetics in operative surgery is now an indispensable 



ANiESTIIETICS. 411 

practice. It may be compendiously stated that ether, or chloroform, is 
required in all surgical operations of magnitude, for the reduction of 
dislocations, for the taxis in strangulated hernia, for dressing painful 
wounds and adjusting fractures, for breaking up adhesions, and con- 
tractions of muscles and tendons in cases of deformity, for establishing 
the diagnosis in feigned diseases, etc. 

The after nausea and vomiting, which are sometimes most depress- 
ing, and occasionally dangerous, produced by anaesthetics, may be pre- 
vented by the hypodermatic injection of morphia and atropia before 
beginning the administration of the anaesthetic. After the patient 
emerges from the anaesthetic sleep, the above-mentioned unpleasant 
after-effects may be relieved by a minute quantity of morphia (^ of a 
grain) and atropia (j^-g of a grain) injected subcutaneously. 

Comparative Utility of Ether and Chloroform. — Chloroform is 
more pleasant to inhale, and is less irritant to the air-passages than 
ether. The vapor of chloroform is not, and the vapor of ether is, in- 
flammable, whence it follows that the former may be alone admissible 
at night under some circumstances. The stage of excitement is longer 
from ether than from chloroform, but, as ether may be given much more 
rapidly, this difference in action may be made to disappear in practice. 
Chloroform is more prompt in its effects, and the narcosis induced by it 
more sustained, than is the case with ether; but these advantages pos- 
sessed by chloroform are quite balanced by the greater freedom with 
which ether may be administered. The danger from the inhalation of 
chloroform is vastly greater than from ether. 

It follows from the above considerations that ether should be used 
in preference to chloroform, in all cases, except during labor. Chloro- 
form is to be preferred in labor, because more pleasant to inhale, more 
prompt in action, and without inflammability. The consideration of 
safety must necessarily take precedence, but experience has shown that 
chloroform is perfectly safe in labor when properly administered. 

The frequency with which fatal cases of chloroform narcosis have 
been reported — amounting in the aggregate now to about five hun- 
dred — imposes an immense responsibility on the administrator. In the 
present state of opinion on the subject, the use of chloroform, when 
ether is available, for the production of anassthesia, can hardly be justi- 
fied, especially if a fatal result follow its administration. 

Authorities referred to : 

Anstie, Dr. Francis Edmund. Stimulants and Narcotics, American edition. 

Boettciier, Prop. Dr. A. Ueber die Wirhung des Chloroforms avf das Blut. Vir- 
chow's- Archiv, xxxii., 1865, 1, p. 126. 

Gcbler, Dr. A. Commentaires Therapeutiques du Codex Medicamentariux, etc., p. 670. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimiltellehre, zweiter Band, 
p. 1034. 

Kohler, Dr. Hermann. Chloroform, Aether und die als Ersatzmitiel des Chloroform 



412 CEREBRAL SEDATIVES. 

empfohlcncn Alkoholderivate zusammengestelh und besprochen. Schmidt's Jahrbucher, vol 
cxlii., p. 209, and vol. cxlv., p. 305. 

Lente, Dr. Frederic D. New York Medical Journal, vol. viii., p. 615. 

Medico-Chirurgical Transactions. Report of the Committee, etc., to inquire in/a 
the Uses and the Physiological, Therapeutical, and Toxical Effects of Chloroform, etc., vol. 
xxix., second series, p. 323. 

Morgan, Dr. J. The Danger of Chloroform and the Safety and Efficiency of Ether, 
London, 1872. 

Nothnagel, Dr. Hermann. Die fettige Degeneration der Organe bei Chloroformvergif- 
lung. Berliner kliuische Wochen., iii., 4, 1866. 

Ibid. Handbuch der Arzneimittellchre, p. 125. 

Petrequin, Dr. J. E. Nouvelles Mecherches sur la Choix d faire entre la Chloroforme 
el V Ether reel., etc., Gaz. Heb., 4-6, 186Y. 

Reeve, Dr. J. C. American Journal of Medical Sciences, October, 1867. 

Richardson, Dr. B. W. The Medical Times and Gazette, 1866-1871, various articles. 

Sansom, Dr. Arthur Ernest. Chloroform : Its Action and Administration, Philadel- 
phia, 1866. 

Simpson, Sir J. Y. Anaesthesia, Hospitalism, etc., Works, American edition. 

Snow, Dr. On Chloroform and other Ancesthetics, London, 1858. 

Squibb, Dr. E. R. New York Medical Journal, April, 1871. 

Trousseau et Pidoux. Traite de Therapculique et de Matiere Medicate, eighth edition, 
vol. ii., p. 301. 

United States Dispensatory, thirteenth edition. 



Local Anaesthesia. — The diminution of the cutaneous sensibility, 
by the application of ice and freezing mixtures, has long been practised. 
It was not, however, until Richardson's method by the hand-ball spray 
apparatus had been proposed, that there had been much use made of 
local anaesthesia. 

This method consists in directing a current of atomized ether against 
the part to be anaesthetized. The ether employed for this purpose should 
have a specific gravity not to exceed 0.723. Rhigolene, the lightest 
liquid known, a product of the fractional distillation of petroleum, ia 
more effective than ether, but great difficulty attends its use owing to 
its extreme volatility. When a current of atomized ether or rhigolene 
is directed against the skin, the rapid evaporation produces an intense 
degree of cold, in consequence of which the nerves lose their power of 
transmitting impressions to the sensorium. 

A serious drawback to the process of producing local anaesthesia is, 
the unpleasant burning which follows in the part when it recovers from 
the freezing, and also the great pain which attends the application of 
ether-spray to certain parts. 

Therapy. — For small operations, such as extraction of teeth, and 
opening abscesses, the method of local anaesthesia is extremely useful. 
It has been, and can be, used with entire success in much larger opera- 
tions, but it is generally employed for merely minor ones. 

The application of ether-spray to the spine is an extremely service- 
able remedy in spinal irritation and in chorea. In the latter disease it 



NITROUS OXIDE. 413 

alone suffices to effect a cure. In neuralgia of superficial nerves, lum- 
bago, muscular rheumatism, etc., the ether-spray affords relief very 
quickly, which may be permanent. 

Nitrous Oxide. — Protoxide of nitrogen. Laughing-gas. 

Composition and Properties. — A colorless, inodorous gas, having 
a slightly sweetish taste, and a specific gravity of 1.527. It consists 
of one equivalent each of nitrogen and oxygen. It increases the rate 
of combustion of inflammable substances. Water at ordinary tempera- 
ture absorbs about three-fourths of its bulk of the gas. By pressure 
and cold the gas may be condensed into a liquid, and can then be stored 
up in suitable vessels for transportation and use. The quantity of the 
gas taken up by cold water may be much increased by pressure, and 
the water will then yield it up on heating. Hence this constitutes a 
convenient mode of storing the gas for preservation. The ordinary 
mode of storing the gas is in gas-bags, holding about eight gallons, in 
gasometers, or in the liquid form in strong metallic casks. 

Physiological Actions. — The first surgical operation performed with 
a modern anaesthetic was the extraction of a tooth, the subject being 
unconscious from the inhalation of nitrous oxide. It had long been 
known that this gas produced decided exhilaration, when inhaled to a 
certain point. It has a very short anaesthetic stage, unless the inhala- 
tion of the gas be continued. 

The first effect of the inhalation of nitrous oxide is a subjective dizzi- 
ness, whirring noises in the ears, and tingling and loss of sensation 
throughout the body. Extraordinary illusions beguile the senses, and 
the intoxicated subject suddenly breaks forth into singing, declamation, 
sobbing, melancholy, or manifests a pugnacious tendency and assaults 
those about him. As the effects quickly cease, and as the return to 
consciousness is very abrupt, the subject is surprised and ashamed to 
find himself in some ridiculous or grandiose position quite foreign to 
his usual demeanor. 

When used to produce anaesthesia for surgical operations, the inha- 
lation of the gas is forced, and the stage of excitement is very brief. 
The countenance assumes a frightful aspect, most alarming to those 
who have not witnessed the inhalation of the gas. The face becomes 
deadly pale, the respirations, at first shallow, soon assume a stertorous 
character, the jaw becomes fixed, the eyes protrude, and the pallor of 
the face is presently replaced by a bluish and purplish tint. 

So far as the exterior phenomena can afford any indication of the 
nature of the action, the condition produced by nitrous oxide is an 
asphyxiated state. The blood ceases to be oxygenated, carbonic acid 
accumulates, and the centres of conscious impressions are rendered in- 
active in consequence of the deficient supply of oxygen, and the excess 
of carbonic acid. The rational indications of the nature of the narcosis 



414 CEREBRAL SEDATIVES. 

produced by nitrous oxide are confirmed by physiological experiment. 
It has been found that the exhalation of carbonic acid is decidedly 
diminished by the inhalation of nitrous oxide, and that animals live no 
longer in an atmosphere of this gas than in an atmosphere of nitrogen. 

The inhalation of nitrous oxide appears to be almost free from dan- 
ger, and it is rare that unpleasant after-effects follow its administration. 
Two fatal cases have certainly occurred, which can with propriety be 
attributed to the lethal action of this gas, and various cases have fallen 
under the observation of the author in which nervousness, vague mental 
symptoms, and headache, have been experienced after the inhalations. 

Theeapy. — The very prompt action of nitrous oxide and the quick 
subsidence of the narcosis render it a very useful anaesthetic agent 
when small operations, quickly executed, are to be performed. It is 
especially adapted for the extraction of teeth, opening of abscesses, and 
similar minor operations. But it has also been used successfully for 
maintaining prolonged anaesthesia for the performance of capital oper- 
ations. There is no difficulty in keeping up insensibility from fifteen 
minutes to a half-hour, since the introduction of liquefied gas and of 
apparatus for its suitable application. 

Authorities referred to : 

Amort, Dr. Robert. The Physiological Action of Nitrons Oxide. New York Medical 
Journal, August, 18*70. 

Johnson, Dr. George. A Lecture on the Physiology of Coma and Anaesthesia. Medi- 
cal Times and Gazette, April 3, 1869. 

Joltet et T. Blanche, MM. Recherches experimental es sur V Action du Gaz protoxyde 
d' Azote. Bulletin General de Therap., vol. lxxxv., p. 91. 

Richardson, Dr. B. W. Medical Times and Gazette, vol. i., 1868. 

United States Dispensatory, thirteenth edition, p. 1656. 

Chloral. — Hydrate of chloral. Chloral, Fr. ; Chloralhydrat, Ger. 

" A white, crystalline mass having a pungent odor and taste, soluble 
in its own weight of distilled water, and readily soluble in alcohol. 
When heated it fuses and evaporates without residue, and in the open 
air without combustion. The aqueous solution is not precipitated by 
the nitrate of silver, and, when mixed with an equal bulk of nitric acid 
and heated, no red vapors are evolved. The solution acidulated with 
sulphuric acid, and faintly tinged with permanganate of potassium, is 
not decolorized within three hours. The crystals float on sulphuric acid, 
and, when the two are agitated together, the acid becomes temporarily 
turbid, but remains colorless after being heated." 

Dose, grs. v — 3 j, or more, but it should not be forgotten that 3 ss 
has produced toxic symptoms. 

Antagonists and Incompatibles. — The depression of the heart and 
respiration caused by chloral is antagonized by alcoholic stimulants, 
ammonia, atropia, by galvanism, and by artificial heat. These are, 



CHLORAL. 415 

therefore, appropriate remedies to be employed in cases of poisoning. 
Strychnia is held by Liebreich to be antagonistic, and hence it may 
be administered hypodermatically when the measures above mentioned 
are being used. 

Alkalies decompose chloral with the production of formic acid and 
chloroform, hence all agents having an alkaline reaction are incom- 
patible. 

Synergists. — The hypnotic medicines, notably opium, and the an- 
aesthetics, deepen the effects of chloral when they are simultaneously 
administered. 

Physiological Actions. — Chloral has considerable antiseptic prop- 
erty, and is preservative of animal textures. It produces redness and 
inflammation of the skin, when kept in contact with it for a lengthened 
period. The taste of chloral is hot and pungent, and it excites an 
abundant flow of saliva. In the stomach it causes first a cooling sensa- 
tion, followed by warmth, and when taken in large quantity may set 
up a high degree of gastric irritation, nausea, and vomiting. In moder- 
ate quantity chloral rather stimulates than impairs the appetite, and 
indigestion and nausea do not, as a rule, follow as an after-effect. 

Cljloral diffuses into the blood rapidly. The changes which occur 
after its entrance into the vessels is much disputed. Liebreich, as is 
well known, was led — by observing the reaction when chloral is brought 
into the presence of an alkali — to the deduction that the soda of the 
blood would split up chloral into chloroform and formic acid, and that, 
therefore, the effects belonging to chloroform might be produced by the 
administration of chloral. It is probably true that this reaction does 
take place to some extent, but there are several insuperable objections 
to the theory of Liebreich : 

1. The effects of chloral differ from those produced b} T a correspond- 
ing quantity of chloroform. 

2. After the administration of chloral, there is no elimination of 
chloroform by the breath or urine. 

3. Chloral is more decidedly hypnotic, and much less anaesthetic, 
than chloroform. 

4. Crystals of chloral have been recognized in the blood, and the 
products of the decomposition of chloral have recently been recovered 
from the urine. 

The effects which follow an ordinary medicinal dose (fifteen to thirty 
grains) are not the same in all subjects, although it must be admitted 
that a great degree of uniformity exists. "When there is present an 
insusceptibility to its hypnotic action it produces headache, and in some 
subjects a delirious excitement. Immediately preceding its hypnotic 
action there is developed in all subjects a stage of excitement, usually 
very short in duration, and followed by sudden and complete sopor. 
The sleep produced by chloral is extraordinarily like natural sleep, and 



416 CEREBRAL SEDATIVES. 

is calm, dreamless, and refreshing. It is not a condition of narcotism, 
and the patient may be easily aroused to take food and nourishment, 
and will quickly and without difficulty fall asleep again. As a rule no 
unpleasant after-effects are experienced from a dose of chloral — no head- 
ache, faintness, giddiness, nausea, and constipation, so common after 
morphia. The quantity of chloral necessary to produce sleep, without 
dangerous narcotism, ranges from fifteen to forty grains, and the dura- 
tion of the effect varies in different subjects from two to eight hours. 
Chloral does not destroy the sensibility to pain, unless administered in 
a quantity sufficient to suspend the functions of the cerebrum. It is 
not a pain-relieving agent in the sense that morphia is. 

When sleep is produced by proper medicinal doses of chloral the 
pupil contracts a little, the pulse may remain unaltered or become 
slower, and the respirations are unaffected. When a dangerous or 
lethal dose is taken, profound narcotism will follow ; the respirations 
will be slower and shallower, the pulse will become weak, rapid, and 
irregular; sensibility and the reflex movements will be abolished, and 
complete muscular relaxation will ensue. The mode of dying is by 
suspension of the functions of the cerebrum, and, finally, by paralysis 
of the respiratory centre, and of the cardiac motor ganglia. Death 
may be suddenly produced by paralysis of the heart, in cases of fatty 
degeneration of the muscular tissue of this organ, without proceeding 
so far as to involve the lower centres of the brain. 

A marked reduction in temperature, notably in rabbits — so much as 
8° Fahr. — is produced by chloral, but this effect may be considerably 
lessened by enveloping the body in non-conductors (Brunton), which 
act by preventing the cooling of the blood by the atmosphere. The 
first effect of chloral is to raise the arterial tension (stage of excite- 
ment), but this action quickly ceases, and a decided lowering of the 
tension results. The diminished arterial tension and the weakened 
action of the heart are the principal factors in the reduction of the 
body temperature, for the combined action of these agencies is to lessen 
the combustion process. After death from chloral, congestion of the 
meninges of the brain and cord, of the lungs, and distention of the 
right cavities of the heart, have been observed. The arrest of the heart's 
action takes place in the diastole. 

Chloral does not affect the motor nerves nor impair the contractility 
of muscle ; hence the paralytic phenomena both of animal and of organic 
life produced by it are due to its direct action on the nervous centres. 

Very large quantities of chloral have been taken without producing 
fatal symptoms. I have seen a patient who took daily from two drachms 
to three drachms of chloral for many months, without any symptoms 
of acute poisoning. While it is true that enormous doses (several 
hundred grains) have been taken without producing lethal effects, it is 
equally trn" that serious symptoms and death have resulted from very 



CHLORAL. 417 

moderate doses (twenty to thirty grains). Great care should therefore 
be taken in prescribing an agent of such uncertain power. A fatty 
heart, atheromatous degeneration of the vessels, advanced disease of 
the lungs, and instability of the nervous system, are contraindications 
of the use of chldral. 

Chloral-Habit. — The habitual use of chloral constitutes a disorder, 
which, if not as persistent as the opium-habit, has its own difficulties 
and dangers of no little importance. Those who take chloral habitually 
have irritable, injected, and rather brilliant eyes, and are voluble in 
speech, and have a rather excited and hurried manner. They complain 
usually of singing in the ears, of an empty or vacuous feeling in the 
brain, and are subject to sudden attacks of vertigo. They are wakeful, 
and very nervous and excitable, without chloral, when the time for 
sleep arrives, and they are usually entirely unable to sleep without the 
usual dose of the hypnotic. During the day they are melancholy, 
easily fatigued, and their voluntary movements are apt to be uncertain 
and disordered. The appetite is always capricious, frequently wanting; 
digestion is labored ; the secretion of bile is deficient, the stools being 
rather white and pasty ; the urine stained with the bile-elements, and 
sometimes albuminous. 

An increasing weakness and irregularity in the action of the heart ; 
dyspnoea, chiefly when the stomach is distended ; redness, injection, 
and ecchymoses of the skin, have been occasional^' observed to occur in 
cases of the chloral habit. 

The best method of managing these unfortunate cases consists in the 
very gradual diminution of the daily quantity of chloral ; in regulation 
of the diet and administration of a suitable supply of food; air, exer- 
cise, and change of scene ; chalybeate tonics, with hyoscyamus and 
lupuline ; occasional purgatives. 

Therapy. — Chloral is a remedy of great value in sea-sickness. 
From fifteen to thirty grains every four hours, the recumbent posture 
for a short time, and suitable nourishment, are the most effective means 
we now possess for this troublesome disorder. In some cases of sick- 
ness of pregnancy chloral is equally effective, but, like other remedies 
for this condition, it often fails. According to the author's observation 
it is most effective when there is much dizziness, faintness, and repug- 
nance to food, and but little vomiting. When the odor of chloral in- 
vites nausea, as is not unfiequently the case, it may be given advan- 
tageously by enema. 

In severe cases of cholera-morbus, with cramps, coldness of the 
surface, cold breath and cold tongue, remarkable relief is procured, and 
the patient not unfrequently wrested from a condition of extreme dan- 
ger by the hypodermatic injection of chloral. There is no means of 
treatment of cholera now known so effective as this, as the author has 
personally witnessed. The effectiveness of chloral is increased by com- 
£8 



418 CEREBRAL SEDATIVES. 

bination with morphia. R. Chloral, hydratis, 3 iij ; morphiae sulph„ # 
gr. iv ; aquas laur.-cerasi, 3 j. M. Sig. From fifteen to thirty minima 
— -for cholera, cholera-morbus, etc. This injection produces considera- 
ble burning pain and an indurated lump, but in the author's experience 
suppuration has not followed. 

As chloral produces a lowering of the temperature, and, according 
to Richardson, diminishes the coagulability of the fibrine, good results 
may be expected from its use in inflammations and fevers. It is 
especially indicated when the temperature is high and there are much 
delirium and restlessness present. The author has observed excellent 
results from its use under these circumstances in the eruptive fevers, 
pneumonia, etc. It should not be forgotten, however, that chloral must 
be prescribed with caution when there is ischasmia of the arterial sys- 
tem — a condition which must necessarily exist when a considerable 
portion of the lung-space is blocked up by fibrinous or caseous deposi- 
tions. In pleuritis, endo- and pericarditis, and in peritonitis, much 
good will result from the use of moderate doses of chloral — five grains 
every three hours. It is useful because it allays restlessness, causes 
sleep, lowers the fever, and limits or prevents fibrinous deposits and ex- 
udations. 

The most important uses of chloral are in diseases of the nervous 
system. As an hypnotic, pure and simple, it is quite unrivaled. Cases 
of sleeplessness, due to mental overwork, anxiety, or physical fatigue, 
are entirely relieved by fifteen to twenty grains of chloral. The re- 
freshing sleep thus obtained not unfrequently leads to repeated and 
long-continued use of .chloral, and thus the chloral-habit is formed. It 
follows that sleep should be procured by proper hygienic methods in 
such cases, if possible, and chloral should be resorted to only after the 
failure of such means. No hypnotic is so uniformly successful in pro- 
curing sleep in delirium tremens ; but this remedy, as other remedies 
of the same class, not unfrequently fails. It is more particularly adapted 
to those cases in which the delirium has succeeded to a debauch, and is 
less useful, and may, indeed, produce serious symptoms, in old, worn-out 
drunkards. Violent excitement not unfrequently is produced by it when 
it fails to cause sleep. The author must caution his younger readers 
against the too large administration of chloral in this disease. Sleep 
may be procured which will end in fatal exhaustion. Especially should 
caution be use in old drunkards, whose heart and vascular system may 
have undergone serious fatty and calcareous degeneration. In suitable . 
cases there is no doubt chloral is a remedy of the highest value, but it 
should not be used to the exclusion of suitable hygienic and dietetic 
treatment. 

Various forms of mania, in which delirium and wakefulness are 
prominent symptoms, are largely benefited by hypnotic doses of chlo- 
ral. This remark is true of acute mania, acute melancholia, puerperal 



CHLORAL. I ] !) 

mania, acute maniacal delirium, and the excitement which occurs in 
general paralysis of the insane. When it agrees, and produces re- 
freshing sleep, marked improvement in the mental state not unfre- 
quently follows its use. In incurable and intractable cases, chloral 
often renders the greatest service as a calmative and an hypnotic. 

Puerperal convulsions, when the patient is in a condition to swal- 
low, may be arrested by full doses of chloral — twenty grains every two 
hours. Infantile convulsioJis, when due to reflex irritation, may be 
suspended by the same means. When the jactitations of chorea are so 
incessant as to prevent sleep, or when they occur during sleep, chloral 
may be administered with advantage. It is not a curative agent in 
chorea, but when it produces quiet and refreshing sleep it indirectly 
contributes to the cure. 

Some of the respiratory neuroses are greatly benefited by chloral. 
The paroxysms of spasmodic asthma may be arrested by it, and the 
spasmodic attacks of difficult breathing which accompany emphysema 
may be decidedly ameliorated by timely doses of chloral. It must not 
be forgotten, however, that the use of chloral is not unattended with 
danger in pulmonary diseases with ischremia of the arterial system. In 
the spasmodic stage of whooping-cough, great relief to the paroxysms 
may be obtained by the use of this agent. From five to ten grains will 
generally be a suitable quantity for administration in these cases. Im- 
pending attacks of laryngismus stridulus may be prevented, and seiz- 
ures already in action can be quickly arrested by a full dose of chloral — 
five to fifteen grains. 

We have no remedy more effective in tetanus than chloral, but it 
must be given in large doses. Nocturnal attacks of epilepsy may not 
unfrequently be prevented by a full dose of chloral at bedtime. In 
paralysis agitans, good effects have been attained by hypnotic doses at 
bedtime. Chloral is a physiological antagonist to strychnia, and may, 
therefore, be used with advantage in poisoning by this substance. 

Chloral is not unfrequently prescribed to relieve pain, but under a 
mistaken notion of its physiological powers. It can only relieve pain 
by suspending the functions of the cerebrum, and in doses, therefore, 
which are dangerous. It has no direct pain-relieving power, like mor- 
phia. When pain is to be relieved and sleep procured, the combination 
of chloral and morphia is extremely effective. 

Although chloral does not directly suspend the functions of the sen- 
sory nerves, it relieves certain kinds of pain due to irregular or overac- 
tion of unstriped muscular fibres. Very great relief is afforded by 
chloral, to the irregular pains of the first stage of labor, which cause 
suffering but do not advance the case — the so-called " nagging-pains " 
in popular obstetric language. jRigidity of the os uteri and soft parts 
may be corrected by the timely administration of chloral, and exhaus^ 
tion may be prevented by giving it in such a way as to suspend irregu- 



420 CEREBRAL SEDATIVES. 

lar uteriue action and to procure sleep. After-pains are stopped by 
chloral. In all these cases of obstetric diseases, large doses are gener- 
ally required. 

A solution of chloral is an excellent antiseptic application to foul 
wounds: it destroys the odor of putrefaction, arrests fermentative 
changes, and promotes the formation of healthy granulations. It may 
be used to preserve anatomical preparations and morbid specimens. A 
weak solution of chloral (gr. j to grs. iv — 3 j) is an excellent injection 
in gonorrhoea. 

Equal parts of chloral and camphor, triturated together, form a clear 
fluid, which is often of great service in neuralgia, applied to the affected 
part. It is painted lightly over the surface with a camel's-hair brush, 
and is allowed to dry on. It is said to allay spasmodic cough when 
painted over the larynx. 

Authorities referred to : 

Amoht, Dr. Robert. The New York Medical Journal, vol. xv., p. 606. 

Andrews, Dr. J. B. The Physiological Action and Therapeutic Use of Chloral, Utica, 
N. T., 1871. 

Browne, Lennox. The British Medical Journal, March 7, 18*74, p. 304. 

Da Costa, Dr. J. M. Clinical Notts on Chloral. American Journal of Medical Sci- 
tnces, April, 1870, p. 359. 

Demarqtjat, M. Notes sur le Chloral. Bulletin de Therapeutigue, vol. lxxvii., p. 307. 

Husemann, Dr. Theod. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 1088. 

Keen, Dr. W. W. The Anatomical, Pathological, and Surgical Vies of Chloral. 
American Journal of Medical Sciences, July, 1875. 

Liebreich, Dr. Oscar. Das Chloralhydrat, ein neues Hypnolicum und Anatstheticum, 
und dessen Anwendung in der Medicin, zweite Auflage, Berlin, 1869. 

Lange, Dr. Ueber die WirJcung des Chloralhydrat. Berliner klinische Wochenschrifl, 
No. 10, 1870. 

Personne and Bouchut, MM. The Medical Times and Gazette, vol. xi., 1869, p. 605. 

Richardson, Dr. B. W. On the Physiological Actions of Chloral. Tlie Medical 
Times and Gazette, vol. xi., 1869. 

Reynolds, Dr. J. Rossell. The Practitioner, vol. iv., p. 188, March, 1870. 

Tomaszewicz, A. Die Wirkungen des Chloral und der Trichloressigsdure. Archiv 
fur Physiologie, ix., p. 35, Mai, 1874. Schmidt's Jahrbiicher, No. 8, 1S74. 

Wells, Mr. Spencer. On Hydrate of Chloral and its Use in Practice. The Medical 
Times and Gazette, vol. xi., 1869. 

Croton-Chloral Hydrate. — This substance occurs in rather small and 
brilliant tabular crystals. It is soluble in water, but not freely so ; and, 
as respects antagonists and incompatibles, may be classed with chloral 
hydrate. Dose, grs. ij — grs. xv, largely diluted in water. It may also 
be conveniently made into pills with glycerite of tragacanth. 

Physiological Actions and Therapy. — Croton-chloral resembles 
chloral in its hypnotic action, but it is feebler and also less certain. As 
in lethal doses it causes death by paralysis of respiration, it is admis- 



OPIUM. (J I 

Bible in cases of weak heart. It differs from chloral, especially in the 
singular property which it possesses of causing anaesthesia of the head. 
Oroton-chloral is much less certain in its effects than chloral : sometimes 
one or two grains will relieve severe trigeminal neuralgia ; and often 
from five to fifteen grains are necessary. When pain is to be relieved 
and sleep procured, the best results are obtained by a combination of 
the two agents. 

Croton-chloral has proved very effective in various neuralgia. It 
been especially useful in tlc-douloureux, in which it should be given in 
doses of two to five grains every hour or two, until fifteen grains have 
been taken. It is probably not safe to exceed this amount at one time. 
The pains of dysmenorrhcea and sciatica have also been relieved by the 
use of this remedy. 

Authorities referred to : 

The British Medical Journal, October 30, 1873, March 7, 1874. 
Schmidt's Jahrbuciier. Papers by Profs. Liebreich, Benson, Baker, and Wickham 
Legg, Band 161, p. 16. 

Opium. — Opium. Opium, Fr.; Opium, Ger. "The concrete juice 
obtained from the unripe capsules of papaver somniferum, by incision 
and spontaneous evaporation." 

" Opium, when dried at 212° until it ceases to lose weight, should 
yield at least ten per cent, of morphia by the officinal process." 

Confectio Opii. — Confection of opium. (Opium, aromatic powder, 
honey.) Dose, thirty-six grains of the confection contain one grain of 
opium. 

Emplastrum Opii. — Plaster of opium. (Extract of opium, Burgun- , 
dy pitch, and lead-plaster.) 

Extracticm Opii. — Extract of opium. Dose, gr. ss — grs. ij. 

JPilulai Opii. — Pills of opium. Dose, one to four pills. Each pill 
contains one grain of opium. 

Pllulce Saponis Composite. — Compound pills of soap. (Opium and 
soap.) Five grains contain one grain of opium. 

Pulvis Ipecacuanhas Compositus. — Compound powder of ipecacu- 
anha. Dover's powder. Ten grains contain one grain each of ipecac, 
and of opium, and eight grains of sulphate of potash. 

Tlnctura Opii. — Tincture of opium. Laudanum. Thirteen minims 
or twenty-five drops are equivalent to one grain of opium. 

Tlnctura Opii Acetata. — Acetated tincture of opium. Ten minims 
or twenty drops are about equal to one grain of opium. 

Tlnctura Opii Gamphorata. — Camphorated tincture of opium. 
Paregoric. Half a fluid ounce contains nearly one grain of opium. 
Dose, for children, from gtt. v — gtt. xx ; for adults, from 3 j — i j. 



422 CEREBRAL SEDATIVES. 

Tinctura Opii Deodorata. — Deodorized tincture of opium. Dose, 

m. v— 3 j. 

Vinum Opii. — Wine of opium. (Opium, cinnamon, cloves, sherry 

wine.) Dose, m. v — 3 j. 

Composition. — About half of the weight of opium is made up of 
gum, pectine, albumen, and fragments of the poppy-capsules, and calca- 
reous salts. It contains, also, some coloring-matter, and a volatile sub- 
stance in minute quantity. The proportion of water varies from twelve 
to thirty per cent. A large number of basic, acid, and neutral sub- 
stances have been and are still being discovered in opium, hence its 
chemistry is very complex. 

The following natural alkaloids have been found in opium. "Various 
derivatives of these have also been described. This list, except some 
unimportant modifications, is taken from Fliickiger and Hanbury's ad- 
mirable Pharmacographia : 

Mydrocotarnine.— Crystallizable, alkaline. Volatile at 100°. (C„ 
H u N a 3 .) 

Morphine (morphia). — Crystallizable, alkaline. (C^H^NjO,.) 
Pseudo-morphine. — Crystallizes with H a O, does not unite even with 

acetic acid. (^H^NjO,.) 

Codeine (codia). — Crystallizable, alkaline, soluble in water. (C 18 H„ 

NA.) 

Thebaine (thebaia). — Crystallizable, alkaline. (C^H^NjO,.) 

Protopine. — Crystallizable, alkaline. (C^H^NA-) 

JOaitdamine. — An alkaloid, which, as well as its salts, forms large 

crystals. (C^^O,) 

Codamine. — Crystallizable, alkaline ; can be sublimed. (C, H 3I5 

N.O,) 

Papaverine (papaverina). — Crystallizable, alkaline. (C^H^NjO^) 

Mhoeadine. — Crystallizable, not distinctly alkaline ; can be sublimed. 

(c s MO,) 

Meconidine. — Amorphous, alkaline ; melts at 58° ; not stable ; thr 
salts also easily altered. (C a H 93 N 1 4 .) 

Cryptopine (cryptopia). — Crystallizable, alkaline ; salts tend to ge 
latinize ; hydrochlorate crystallizes in tufts. (C^H^NjO,.) 

Laudanosine. — Crystallizable, alkaline. (C 21 H 27 N 1 4 .) 

JVarcotine (narcotina). — Crystallizable, not alkaline ; salts not stable. 

Lanthopine. — Microscopic crystals, not alkaline. (C^H^NjO^) 

JVarceine (narceina). — Crystallizable as a hydrate; readily soluble 
in boiling water or in alkalies. (C 23 H a9 N,0 9 .) 

The only important derivative in the therapeutic sense is apomor- 
phia, obtained from morphia by the action of hydrochloric acid. This 
possesses active emetic property, and will be grouped with emetics. 

Besides the foregoing aikaloidal and basic substances, opium con- 



OPIUM. 423 

tains a peculiar acid (meconic acid), and, according to T. and H. Smith, 
a peculiar form of lactic acid (thebolactic). 

The proportion of morphia in Turkey opium should not be less than 
ten per cent., and in good specimens may reach fifteen per cent. 
Pseudo-morphine occurs in the minute quantity of 0.02 per cent. The 
proportion of codeine varies from one-fifth to two-fifths per cent.. The- 
baine and papaverine exist in Turkej' opium in about the proportion 
of one per cent. Narcotine is found in considerable quantity in differ- 
ent varieties of opium, and ranges in amount from one and five-tenths 
to ten per cent. Narceine varies from 0.1 to 0.71. The quantity of 
cryptopine and rhceadine is extremely small. 

The morphia of opium exists in the drug in the form of the tri- 
basic meconate. The proportion of meconic acid is about three to four 
per cent, of the crude opium. 

The value of opium depends on the quantity of morphine which it 
contains. 

Morphia. — " In colorless crystals, which are inflammable and wholly 
dissipated by red heat. It is scarcely soluble in cold water, slightly so 
in boiling water, and freely soluble in boiling alcohol. Nitric acid first 
reddens it, and then renders it yellow. With a solution of sesqui- 
chloride of iron, it assumes a deep-blue color. Its solution restores the 
color of litmus, previously reddened by an acid." 

3forphice Acetas. — Acetate of morphia. " A white powder, wholly 
soluble in water and in alcohol. From its solution potassa throws down 
a precipitate, which is dissolved by an excess of the alkali. It is af- 
fected by heat, nitric acid, and sesquichloride of iron in the same man- 
ner as morphia." Dose, gr. -J — gr. ss. 

Morphim 3Iurias. — Muriate of morphia. li In snow-white, feathery 
crystals, wholly soluble in water and in alcohol." Dose, gr. \ — gr. ss. 

Morphice Sulphas. — Sulphate of morphia. "In snow-white, feath« 
ery crystals, which are wholly soluble in water." Dose, gr. \ — gr. ss. 

Liquor Morphioe Sulphatis. — Solution of sulphate of morphia 
(Morph. sulph., gr. viij ; water, § viij.) Dose, 3 j — 3 ij. 

Trochisi Morphiaz et Ipecacuanha*. — Troches of morphia and ipe- 
cacuanha. (Morphia, ipecac, sugar, oil of gaultheria, mucilage.) 

Liquor Morphiaz Bimeconatis. — Solution of the bimeconate of mor- 
phia. Same strength as laudanum. Dose, m. x — m. xx. 
The other alkaloids of opium are not officinal. 

Codies Sulphas. — Sulphate of codia. Dose, gr. \ — gr. j. 

N~arcotinaz Murias. — Muriate of narcotine. Dose,' gr. ij — gr. x. 
As an antiperiodic. 

Antagonists and Incompatibles. — As regards chemical antago- 
nism the alkaline carbonates, Lime-water, and the salts of iron, lead, 
copper, zinc, mercury, and Fowler's solution, are incompatible with the 



424 CEREBRAL SEDATIVES. 

preparations of opium. Notwithstanding this chemical incompatibility 
the metallic salts are frequently given in conjunction with opium, and 
the systemic effects of both are produced. Astringent vegetables (tan- 
nin) are also incompatible ; they limit physiological activity by forming 
tannate of morphia, which is not readily soluble. 

In cases of opium-poisoning, if any portion of the drug remain un- 
absorbed in the stomach, the most prompt and efficient emetic should 
be used. Apomorphia should be injected subcutaneously, if the patient 
is unable to swallow ; if conscious, the sulphate of copper may be ad- 
ministered by the stomach. In a case of opium narcosis which resisted 
ordinary emetics, violent emesis was induced by a solution of bicarbon- 
ate of sodium, followed by a solution of tartaric acid. In the absence 
of other and more active emetics, powdered mustard may be adminis- 
tered — a tablespoonful to a teacupful of warm water. When the opium 
swallowed is in solution, the stomach-pump should be used if the nar- 
cosis is profound. Cold affusion, artificial respiration, when the breath- 
ing flags, and faradization of the chest-muscles, are measures of great 
practical utility. The author has personally witnessed in several cases 
the excellent effects of faradization, first, in causing such irritation of 
the surface as to produce reflex excitation of the respiratory centre ; 
and, second, inducing contractions of the respiratory muscles: As a 
peripheral irritant, faradization is more humane and seemly, and also 
more efficient than flagellation. 

The action of opium is antagonized, at least in a part of the sphere 
of its influence, by belladonna. These agents are opposed as regards 
their influence on the intra-cranial circulation, on the pupil, on the re- 
spiratory organs, and on the heart. Opium in lethal doses dilates the 
arterioles and veins ; belladonna contracts them, and, by energizing the 
cardiac movements, substitutes an active for a passive congestion. It 
cannot be too strongly insisted on in this connection that belladonna 
in too great quantity, or too long in action, exhausts the irritability 
of the unstriped muscular fibre, and thus induces the very state which 
its administration was intended to relieve. The state of the pupil, the 
action of the heart, and the condition of the reflex movements, are the 
guides to the administration of belladonna in cases of opium narcosis. 
The smallest quantity of belladonna which will dilate the pupil, raise 
the tension of the arterial system, deepen the respiration, and reestab- 
lish the reflex excitability, should be used. The author has a strong 
conviction, arising from some painful personal experience, that it is a 
fatal error to attempt to restore a patient in opium narcosis to com- 
plete consciousness by repeated doses of belladonna. The action of 
these agents combined is to produce profound sopor, and this is not a 
condition of danger so long as the pulse, respiration, and reflex move- 
ments, are in good condition. To substitute belladonna narcosis for 
opium narcosis is only increasing the hazard under which the patient is 



OPIUM. 425 

already struggling. Impatient to afford relief, and assuming that the 
tendency to sleep must be obviated, the physician too frequently, as the 
history of many cases plainly shows, repeats the doses of belladonna 
until its action greatly preponderates, and the irritability of the cardiac 
ganglia is completely exhausted. The author, therefore, feels himself 
warranted in repeating that the utility of belladonna consists in its 
power to maintain the action of the heart, and the respiration, until 
elimination has taken place, and that even coma is of little importance 
provided the respiration, circulation, and reflex movements, are properly 
maintained. 

The hypodermic injection of atropia is the most efficient and satis- 
factory method of employing this physiological antagonist. Not more 
than -j-^-g- of a grain of the sulphate should be administered at a dose, 
and this may be repeated every fifteen minutes (up to three doses) 
until dilatation of the pupil, increased power of the cardiac movements, 
deeper respiration, warmth and dryness of the skin, and flushing of the 
face, are produced. No more can be accomplished by the largest doses, 
and the results of the antagonism - must be awaited. Belladonna con- 
tinues longer in action than opium. In a succeeding chapter, devoted 
to the consideration of the combined administration of opium and bella- 
donna, or morphia and atropia, the nature and degree of the antagonism 
will be more fully elaborated. 

Coffee, with its active principle {caffeine), is also an antagonist to 
opium. Good results have undoubtedly been obtained by the free use 
of black coffee, in milder cases of opium narcosis. The unpleasant con- 
fusion of mind, and vertigo, which in so many subjects are experienced 
after the subsidence of the effects of a medicinal dose, may sometimes 
be removed by a cup of strong coffee. These cerebral effects may be 
prevented, or relieved when they occur, by a full dose of bromide of 
potassium. This discovery, if we may dignify so small a matter by so 
imposing a title, was briefly announced by the author in the first edition 
of his work on "Hypodermic Medication," and was afterward more 
fully set forth in a special memoir by Da Costa, of Philadelphia. 

Gubler has shown that some of the cerebral effects of opium are 
antagonized by quinine. Tartar emetic and digitalis also oppose to 
some extent the action of this remedy on the intra-cranial circulation. 

Synergists. — The cerebral and hypnotic effects of opium are pro- 
moted by alcohol and its derivatives (notably chloral), and, within cer- 
tain limits, by the mydriatics. Its depressing influence on the heart 
and respiratory organs is favored by aconite, veratrum viride, lobelia, 
gelsemium, etc. The sudorific action of opium is increased by ipecacu- 
anha. 

Physiological Actions. — As opium is a very complex substance, 
made up of numerous principles which differ remarkably among them- 
selves, it will conduce to a better understanding of its actions to con- 



42G CEREBRAL SEDATIVES. 

sider, first, opium as a whole, and then follow with some details regard, 
ing its individual constituents. 

The phj'siological effects of opium are best studied as respects — 1. 
Small medicinal doses ; 2. Full medicinal doses ; 3. Lethal doses. 

1. The preparations of opium have a disagreeable, bitter, and rather 
nauseous taste. Dryness of the mouth and fauces, huskiness of voice, 
and diminution in the sense of taste, occur in a short time after admin- 
istration of the drug has begun, and continue during the whole period 
of its influence. To the dryness succeeds a viscid secretion, which con- 
tains excrementitious matter having a foul odor. When opium does 
not produce nausea, the appetite may not be impaired, may be even 
increased ; but the rule is that the desire for food is lessened by opium. 
The secretion of mucus, and of the special glandular apparatus of the 
gastro-intestinal mucous membrane, is lessened by opium, and hence the 
digestion and the peristaltic movements are less active. The excretions 
being thus locked up, dullness and hebetude are experienced, the skin 
looks muddy, the tongue is coated, and the breath is offensive. "When 
the influence of the opium ceases, it not unfrequently happens that the 
constipation is succeeded by relaxation of the intestines, and rather pro- 
fuse and fetid evacuations, and increased urinary discharges, take place. 

The action of the heart becomes stronger, and the arterial tension 
rises. When opium agrees, the sense of fatigue vanishes, and muscular 
movements become more rapid and easy. The face flushes a little, the 
pupil contracts slightly, the conjunctivas may be somewhat injected, and 
the expression of the eye more brilliant. At this stage the ideas flow 
more rapidly, but are less sustained and orderly. The appreciation of 
time, the sequence of events, and the sense of moral fitness, are dimin- 
ished. The cerebral excitement is, after a period which varies in dif- 
ferent individuals, succeeded by calm, by drowsiness, and sleep when 
it occurs is usually disturbed by visions and dreams, often of a frightful 
character. In most subjects, after the sopor has passed off, headache, 
vertigo, confusion of mind, nausea, constipation, and muscular hebetude, 
are experienced. 

2. When full medicinal doses are administered the symptoms above 
described occur in a more intense degree. The stage of cardiac stimu- 
lation and of cerebral excitement is of much shorter duration; and the 
stage of intoxication and sopor not only comes on more quickly, but is 
much more pronounced. At first the pulse is increased in frequency 
and the respiratory movements are more rapid ; but the cardiac pulsa- 
tions soon dimmish in number and force, and the respirations become 
sighing in character and more shallow. There is also present decided 
dryness of the mouth, fauces, and larynx, and swallowing becomes some- 
what difficult and the voice grows husky. Nausea and vomiting, or at 
least weight and oppression of the epigastrium, ensue. Confusion of 
ideas, vertigo, somnolence, are succeeded by deep sleep, contracted pu- 



OPIUM. 427 

pils, slow and relaxed pulse, slow and snoring respirations, a perspiring 
6kin, and, in many persons, an intense general pruritus, which, however, 
is more harassing at the nasal orifices. 

Persons not habituated to the use of opium usually experience, after 
a full medicinal dose has expended its force, very distressing sequelae, 
referable to the cerebro-spinal system. The most important of these 
after-effects are headache, confusion of mind, vertigo — which is especially 
severe on assuming the erect posture — nausea, retching and vomiting, 
complete anorexia, and constipation. A mild but defined hepatogenic, 
jaundice not unfrequently occurs, and the urine is tinged with the 
coloring-matter of the bile. 

3. A lethal dose of opium causes but a transient excitement ; the 
stage of narcosis quickly supervenes, and the functions of animal life 
are often rather abruptly suspended. The patient soon lapses into a 
condition of insensibility, with a slow and feeble, or, it may be, rapid 
and feeble, action of the heart ; slow respiration, shallow and quiet or 
stertorous ; face at first flushed, but soon becoming shrunken, pallid, 
and cyanosed ; skin wet ; pupils minutely contracted and insensible to 
stimulation ; unconsciousness profound, with muscular relaxation and 
abolition of reflex movements. This state of opium narcosis is with dif- 
ficulty distinguished from alcohol narcosis, from cerebral haemorrhage — 
especially in the ^>ons — and from urajmic coma. An attentive consid- 
eration must be given to all available facts in the history of the case, to 
the surroundings of the patient, and to the odor of the breath or other 
excretions, for the symptoms of one of the states above mentioned may 
be represented in another, even to the inequality of the pupils, since a- 
case of opium narcosis has been reported in which such inequality ex- 
isted. 

There are no characteristic structural alterations produced by opium. 
The brain presents the appearance known as the " wet brain " by pathol- 
ogists ; the subarachnoid spaces and the ventricles contain an abnormal 
quantity of serum ; the intra-cranial veins are engorged, and the puncta 
vasculosa are somewhat more numerous. The right cavities of the 
heart and the large venous trunks are usually distended with soft co- 
agula. These appearances are largely due to the mode of dying. In 
consequence of the diminishing frequency of the respiratory movements 
the blood is imperfectly decarbonized, and the capillary circulation of 
the lungs is impeded. The action of the heart being weak and the re- 
sistance a fronte increased, it is obvious that venous stasis must take 
place. 

It is necessary now to consider somewhat more minutely the nature 
and'degree of the action of opium on the different organs and systems 
of the body. It will save space and avoid repetitions to study these 
actions in connection with the several principles contained in opium. 

The Physiological Action of the Alkaloids of Opium. — 1. Mor- 



428 CEREBRAL SEDATIVES. 

phia, — The peculiar powers of opium are represented chiefly in the 
' morphia which it contains. In opium of good quality the proportion of 
morphia is from ten to fifteen per cent. The actions of the other princi- 
ples contained in opium differ widely ; and as they all possess some 
activity, the sum of their effects must so far influence the result that the 
powers of opium and morphia must vary somewhat in kind as well as 
in degree. One-sixth of a grain of morphia is about equivalent in ac- 
tivity to one grain of average opium. 

In general terms, it may be stated that morphia differs from opium 
in the following respects : 

Morphia is less stimulating, less convulsant, and more decidedly 
hypnotic and anodyne than opium. 

Morphia constipates less and affects the contractility of the bladder 
more than opium. 

Morphia has less diaphoretic action and produces much more pruri- 
tus than opium. 

The physiological action of morphia is best studied as administered 
subcutaneously. In a short period — from a few seconds to ten minutes 
— after the insertion of an ordinary dose — one-sixth to one-fourth of a 
grain — under the skin, the symptoms of morphia narcosis begin. A 
sense of heat and flushing of the face — after, in most subjects, a very 
transient pallor — fullness of the head, giddiness, tinnitus aurium, and 
frequently nausea, are experienced. Deep-seated epigastric pain is 
often felt, and loud borborygmi occur. The vertigo may be so consid- 
erable as to render walking uncertain and staggering, or to render the 
upright position impossible. Injection of the conjunctivas and con- 
traction of the pupils occur at the same time the cerebral effects are 
experienced. The lips have a bluish appearance, the mouth and tongue 
become dry, swallowing is painful, and the voice has a husky tone. 
When these physiological effects are produced, pain and spasm are 
relieved, and an indescribable feeling of content takes possession of the 
mind. A condition of somnolence in many persons, in others of ex- 
treme wakefulness, with intense mental activity, is experienced. When 
sleep occurs it is usually deep but not calm, the respirations are slow, 
noisy, and labored. Not unfrequently the sleep is disturbed by dreams 
and visions, or the individual passes into a somnambulistic state, from 
which he is aroused with difficulty. The action of the heart is dimin- 
ished in frequency, but a decided rise takes place in the arterial tension. 
On ophthalmoscopic examination, a marked increase in the vascularity 
of the retina, and blurring of the papillae, can be discerned. 

Soon after a hypodermatic injection has been practised, itching of 
the nose, and often of the whole cutaneous surface, is experienced. The 
skin is at first dry, but, after a time, diaphoresis begins and is some- 
times profuse. The relaxation of the skin is coincident with a fall in 
the arterial tension. The secretions of the mucous surfaces are at first 



OPIUM. 429 

arrested, as weil as those of the skin. If the morphia be administered 
after a full meal, digestion is suspended for a time. The intestinal 
movements are also arrested for a short period, and constipation is 
therefore produced ; but, very frequently indeed, no change takes place 
in the time in which the alvine discharges occur, or in their number. 
Partly in consequence of the increased action of the skin, the quantity 
of urine discharged is lessened, and, at the same time, difficulty is en- 
countered in its emission. When the desire is felt, an interval of less 
or greater duration elapses before the flow begins, and, as the con- 
tractile power of the bladder and of the ejaculatory muscles is dimin- 
ished, the discharge is feeble and slow, and the last drops linger in the 
urethra. 

With the decline of morphia narcosis a majority of subjects, prob- 
ably, experience headache, confusion of mind, anorexia, and nausea. 

When a lethal dose of morphia has been administered by any mode, 
profound narcotism quickly ensues ; the pulse becomes slow and feeble, 
or rapid and feeble ; the respirations also become very slow and shal- 
low ; the skin cold and sweating ; the face pale, cyanosed, and ghastly; 
the conjunctivae deeply injected ; the pupils minutely contracted, and 
reflex movements entirely abolished. Respiration ceases before the 
action of the heart, as a rule, but in some instances very sudden death 
ensues from paralysis of the heart. 

Half a grain is the smallest dose of morphia which has proved fatal 
to an adult. Five cases, according to Taylor, have been recorded in 
which one grain of the muriate caused death. 

A consideration of the symptoms produced in man by morphia, and 
the results of experiments on animals, prove that it chiefly affects the 
cerebro-spinal functions. In the lower animals, the spinal more; in 
man, the cerebral more than the spinal functions. Morphia first raises 
and afterward lessens the action of the heart and arteries; first stimu- 
lates the pneumogastric end-organs and cardiac motor ganglia, and 
afterward paralyzes both. It causes death chiefly through paralysis of 
the muscles of respiration. 

2. Codia. — According to the author's observations the codia of com- 
merce corresponds closely in action to morphia, but is much feebler. 
Four grains of codia is about equivalent to one grain of morphia. It 
has anodyne and hypnotic qualities. Codia produces sleep freer from 
disturbance, and the after-effects are less disagreeable, than those of 
morphia. The special direction to the pneumogastric nerve ascribed to 
it by some observers, seems to the author to exist in nature. 

3. Narcotina. — This alkaloid is singularly inappropriately named. 
It has but feeble narcotic power. In children considerable doses pro- 
duce a calmative effect and drowsiness, but these results are not ob- 
served in adults. Experiments on animals have shown that narcotine 
'S a convulsant. While pigeons are poisoned only by two or three 



430 CEREBRAL SEDATIVES. 

grains of morphia, administered subcutaneously, the same quantity of 
narcotine causes fatal convulsions. The reverse is true in man. Nar- 
cotine is allied in action to berberia, and alkaloids of that group, so far 
as the effects on man are concerned; and to thebaia, picrotoxine, 
strychnia, and brucia, so far as the effects on animals are concerned. 

4. Narceine. — The most contradictory observations have been pub- 
lished on the action of this principle. By Bernard, Behier, and Eulen- 
burg, it is held to possess remarkable hypnotic power, and to be free 
from stimulating and convulsant action ; by Fronmuller, Harley, Da 
Costa, Mitchell, and others, it is considered feeble, if not inert. The 
physiological actions of narceine, therefore, remain sub judice. Until 
further researches are made with chemically pure narceine, and by com- 
petent observers, it will be safer to give no opinion on the subject of 
its actions and uses. 

The other alkaloids of opium are curiosities of chemical and physi- 
ological research, and may be dismissed in a few words. 

Cryptopia is in a much greater degree than narceine an hypnotic 
and anodyne. 

TJiebaia has a strong convulsant action in animals. 

Various circumstances modify the action of opium. These are 
chiefly age, sex, idiosyncrasy, habitual use, and certain states of the 
system, as the presence oipain, uraemia, etc. 

The extremes of life are relatively more susceptible to the action of 
opium, and especially is the susceptibility to its action great in early 
life. Fatal opium narcosis has ensued in a nursing infant whose mother 
had taken a medicinal dose. A single drop of laudanum has produced 
lethal effects in a child under six months of age. Women are more 
easily affected by opium than men, and they are more apt to be thrown 
into a condition of hysterical excitement than put to sleep. Nausea, 
vomiting, headache, and depression, much more frequently occur in 
women than in men. As a rule, therefore — but to this rule there are, 
of course, numerous exceptions — women are less favorable subjects for 
the administration of opium than men. 

More than age or sex is the action of opium influenced by idiosyn- 
crasy. There are persons so easily affected by it that the minutest 
quantity will cause uncontrollable vomiting, faintness, vertigo, and 
alarming prostration. It is never safe to administer morphia hypoder- 
matically to such subjects, unless in an extremely small dose. 

The habitual use of opium diminishes in a remarkable degree the 
susceptibility to its action. Numerous instances are on record in which 
a pint or more of laudanum has been taken daily, or several hundred 
grains of opium, or a scruple of morphia. The author has met with a 
patient who took a scruple of morphia a day subcutaneously. When 
opium is given by the stomach, for the relief of a chronic painful dis- 
ease, to maintain a constant effect increasing doses are necessary. The 






OPIUM. 431 

power of the stomach to absorb opium is doubtless impaired by frequent 
repetition of the dose, and in consequence of the local action of the 
drug on the nerves of the stomach. Besides this, the susceptibility of 
the cerebro-spinal system steadily declines. The proof of these state- 
ments is afforded by the action of morphia when used subcutaneously 
for long periods. A gradual increase of the dose becomes necessary in 
order to produce a given physiological effect ; but the increase is much 
slower than when it is administered by the stomach. 

Great pain lessens the influence of opium upon the centres of con- 
scious impressions. The quantity in grains is of much less importance 
than the quantity as measured by the physiological reactions. Ursemia, 
or the retention in the blood of urinary excrementitious matters, is sup- 
posed to increase the narcotic influence of opium ; but some facts, to 
be hereafter presented, render it probable that the state of uraemia and 
the influence of opium on the brain are antagonistic. 

Therapy. — Stomach pain, whether simply neuralgic (gastralgia), 
or excited by the presence of food {irritative dyspepsia), or due to 
ulcer or cancer, is relieved by opium. The preparations of morphia are 
better than the crude drug, as a rule, in these cases. The endermic 
application is an excellent mode of procuring relief. The subcutane- 
ous injection, practised in the epigastric region, is still more effective. 
Morphia is frequently combined with bismuth, or zinc, or silver salts, 
in painful stomach diseases. R. Bismuthi subcarb., vel subnitrat., 3 iij; 
morphias sulph., gr. j — grs. ij ; pulv. aromat., 3 j. M. ft. pulv. no. xij. 
Sig. A powder in milk kef ore each meal. The following formula is 
also useful, notwithstanding its unchemical relations: R. Zinci oxidi, 
3 ss; morphias sulph., gr. j — grs. ij. M. ft. pil. no. x. Sig. One pill, 
three times a day, before each meal. A half-grain of the oxide of silver 
may be substituted for the oxide of zinc in the above formula. 

Inflammatory pain, due to corrosive poisons, to peritonitis, etc., 
requires opium. "When the stomach is irritable, and the symptoms 
urgent, the best mode of using the remedy is the hypodermatic injec- 
tion of morphia. Many kinds of nausea and vomiting, stomachal or 
reflex in origin, are arrested by opium preparations. In vomiting of 
cerebral origin, or produced by uraemia, or caused by cirrhosis, the use 
of opium is contraindicated. When vomiting is caused by irritant mat- 
ters, opium is prescribed after the stomach is emptied. The vomiting 
which accompanies the passage of biliary or renal calculi, dysmenor- 
rhoea, etc., is best relieved by opium. Very severe cases of sea-sick- 
ness, and of the vomiting of pregnancy, may be sometimes arrested 
when all other means fail, by the subcutaneous use of a minute quan- 
tity of morphia (one-twelfth to one-sixth of a grain). 

Nothing is more common than the prescription of opium in diar- 
rhoea! diseases, but it is often used without a just appreciation of the 
conditions requiring it. In acute diarrhoea, caused by irritating ali- 



432 CEREBRAL SEDATIVES. 

ments, such astringent laxatives as rhubarb, or mild salines, should 
precede the use of opium. When the evacuations are watery, the best 
results are obtained by a combination of opium with mineral acids, or 
acetate of lead. In acute dysentery opium is a very important remedy, 
but it is often injudiciously employed. If there be fever, much te- 
nesmus, and the stools consist of mucus and blood, the exhibition of 
opium should be postponed until salines have emptied the intestinal 
canal of its contents, and have depleted the distended vessels. An ex- 
cellent method of administration, especially when the dysenteric inflam- 
mation occupies the rectum, is an enema of starch or milk, or a sup- 
pository, containing opium in some soluble form. In chronic dysentery 
opium is indispensable. It is usually combined with arsenic, or with 
the salts of silver, copper, or zinc. In the chronic dysentery of malarial 
origin, the best results are obtained by a combination of arsenic and 
opium, according to a formula already given ; in that form which suc- 
ceeds to the acute disease, opium and sulphate of copper, or zinc, or 
nitrate of silver, or vegetable astringents. 

Nothing can be more satisfactory than the treatment of cholera- 
morbus by the hypodermatic injection of morphia. It is always desir- 
able to secure the expulsion of irritating matters before resorting to 
opiates. For an ordinary case of cholera-morbus from one-twelfth to 
one-sixth of a grain of morphia suffices. In true cholera the utility of 
opium is most evident in the preliminary diarrhoea, but is entirely with- 
out avail in the stage of collapse. Mischief not unfrequently results 
from its use, for patients emerging from the condition of collapse are 
either directly narcotized by the opium which had lain unabsorbed in 
the stomach, or the cerebral symptoms of the secondary fever are greatly 
intensified by it. In cholera infantum opium must be used with cau- 
tion, if not avoided. The subjects of this malady are easily narcotized, 
and the nervous system — an unknown morbid state of which bears some 
close relation to the gastro-intestinal disorder — is rendered so irritable 
by opium that the symptoms are aggravated by it. 

The following formula embodies . a truth of great practical impor- 
tance: As a rule, opium does harm in all gastro-intestinal maladies in 
which there is a deficiency in the proper secretion, or a suspension of 
the functions, of the liver and kidneys. 

Opium gives a degree and kind of relief in hepatic, renal, and satur- 
nine colic, which no other remedy or combination of remedies affords. 
The most prompt and effective form in which the remedy can be admin- 
istered is the hypodermatic injection of morphia. This relieves the pain, 
and relaxes the spasm of the affected tube, and at the same time checks 
the depressing vomiting which attends these cases. The quanthy of 
morphia required will vary from one-fourth to one-half a grain. As the 
effect is immediate, the most prudent practice consists in the adminis- 
tration of o small quantity (one-sixth to one-eighth of a grain) for the 



OPIUM. 4:;:; 

first dose, in order to test the physiological capabilities of the patient, 
and following this in fifteen minutes with a dose of similar size if tlie 
first is well borne and the pain persist. 

Opium, in small doses, is a valuable tonic to a weak and dilated 
heart. When administered simultaneously with digitalis, it obviates 
one of the dangers which may be caused by that agent. In the so- 
called passive haemorrhages, in which not only is the blood altered in 
quality but the tension is low, small doses of opium sustain the powers 
of life, and by increasing the arterial tension lessen the transudation 
through the vessel-walls. Under these circumstances, the dose of opium 
should not as a rule exceed five minims of the tinctures, and it should 
generally be given in combination with ergot, digitalis, tannic and 
gallic acids, acetate of lead, etc. 

The important observation was made by Bernard, and afterward 
illustrated and confirmed by Nussbaum, that the hypodermatic injection 
of morphia, administered before the inhalation begins, prolongs the 
stage of chloroform narcosis with a less quantity of the anaesthetic, 
diminishes the danger of cardiac paralysis, and prevents the after-nausea 
and depression. 

Opium is the most important agent which we possess in the treat- 
ment of various inflammations. Its efficacy depends upon several fac- 
tors : it relieves pain, quiets restlessness, and thus removes from the 
inflammatory process one of its most important elements, viz., an irri- 
table and paretic state of the nerves of the affected part. Besides these 
effects, opium raises the tonicity of the vessels, helps to maintain the 
continuity of the blood-current, and hinders the migration of the white 
corpuscles of the blood. It is especially in inflammations of the serous 
membranes that its highest utility is manifest, e. g., pleuritis, perito- 
nitis, arachnitis. Good reasons exist for believing that the hypoder- 
matic injection of morphia will sometimes cut short (jugulate) these 
maladies, if administered just at their outset. If the period for obtain- 
ing such a fortunate result has passed, the course and duration of these 
diseases can be greatly modified by the judicious use of opium. The 
quantity of opium required will be determined by the effect ; the pain 
should be relieved, the pupils somewhat contracted. A full dose should 
be administered at the beginning of treatment (two to three grains of 
opium — a half grain of morphia), and a given physiological effect be 
maintained by the regular use of smaller doses. Pain is probably the 
surest guide, for the existence of pain indicates that decided opium 
narcosis has not been attained. 

In peritonitis, whether puerperal, traumatic, or the extension of 
intestinal inflammation, no fact of therapeutics is better established 
than. the curative power of opium. Besides its immediate influence 
over the inflammatory process, its indirect action, in maintaining the 
necessary quietude of the intestines, is of the greatest service. In 
29 



434 CEREBRAL SEDATIVES. 

arachnitis, pachymeningitis, basilar meningitis, there are clinical facta 
which tend to show that small doses o¥ some opiate preparation really 
accomplish more than any other remedies. The author is convinced 
that we possess no means of treatment of cerebrospinal meningitis so 
effective as the opiate treatment. The same rule as to the quantity 
required, as that given for peritonitis, should be observed : that quan- 
tity of opium should be administered which will relieve the pains and 
rigidity. The best results are obtained by the hypodermatic injection 
of morphia. When effusion takes place, and stupor and coma ensue, 
the utility of opium is ended. 

In parenchymatous inflammations, experience has shown, opium is 
much less useful. When pain is a prominent symptom, it can be em- 
ployed to relieve it ; in small, stimulant doses, it may be given to main- 
tain the action of the heart. In pneumonia opium is a remedy of very 
doubtful utility. Its narcotic action certainly disposes to pulmonary 
congestion, although it may be cautiously used to allay pain and moder- 
ate cough. 

In fevers — typhoid, typhus, and eruptive fevers — opium was for- 
merly much more frequently prescribed than at present. The cold 
baths, antipyretics, and more favorable hygienic influences, have less- 
ened the violence and diminished the mortality from fevers. The 
maniacal excitement and the low, muttering delirium are not so fre- 
quently observed now as formerly, and hence the use of opium in these 
affections has greatly declined. The discovery of chloral has also dimin- 
ished the use of opium as an hypnotic. Nevertheless, when there is much 
restlessness, wakefulness, subsultus, and delirium, opium may render 
important service. When the delirium is of the low, muttering kind, a 
small quantity of morphia (one-eighth to one-sixth of a grain) may suf- 
fice to procure quiet and refreshing sleep. When the delirium is vio- 
lent, combination of tartar-emetic with opium, on the plan of Graves, 
may have a very happy effect. Or opium may be combined with bella- 
donna, or chloral — the former when the condition is one of great depres- 
sion, the latter when the delirium and wakefulness are excited in char- 
acter. In measles and scarlet fever, when there is a condition of 
profound depression, the eruption being tardy in making its appear- 
ance, and is dusky in hue and ill-defined, beneficial results are experi 
enced from the use of opium, especially when combined with camphor. 

A threatened paroxysm of intermittent fever may be aborted by the 
hypodermic injection of morphia (one-fourth of a grain). This practice 
has a high degree of importance in the pernicious intermittents, when 
time is not afforded for an effective use of quinia. The febrile heat of 
intermittent and remittent fevers may be diminished, and the sweating 
stage induced earlier, by the use of opium in moderate doses (ten min- 
ims of the deodorized tincture every two, three, or four hours). The 
addition of morphia to quinia enables the latter to be better borne by 






OPIUM. 435 

the stomach, counteracts some of its unpleasant effects on the brain, 
and increases its therapeutical power. When no contraindication to 
the use of morphia exists, it is good practice to combine it with quinia 
in the treatment of intermittent and remittent fevers. 

Narcotine has decided antiperiodic power, and may be given as a 
substitute for quinia when reasons exist to prevent the use of the latter. 
From five to ten grains of pure narcotine may be administered. As an 
antiperiodic it ranks after arsenic, salicine, and even apiol. 

As an hypnotic opium is very frequently used in affections of the 
nervous system. The stimulant properties of crude opium, or its offi- 
cinal preparations, render it less serviceable than morphia in the group 
of cases generally requiring an hypnotic. There can be no doubt that 
remarkable curative results have followed the hypodermatic injection 
of morphia in acute mania. The following are the indications for the 
use of morphia in mental disorders : prolonged wakefulness, maniacal 
excitement, persistent refusal of food, drink, or medicine, destructive 
and suicidal tendencies. As respects individual subjects, the state of 
the arterial tension furnishes a guide to the use of morphia. If the 
tension of the arterial system is low a small dose is required. When 
the pulse is quick, and the arterial tension high, a large dose of morphia, 
by over-excitation, causes paresis of the sympathetic, and thus reduces 
action, an indication for the full influence of the agent. Large doses of 
morphia, when given subcutaneous^, require the utmost circumspection 
in maniacal cases, especially in obese and aged subjects. Besides acute 
mania, excellent results have followed from the use of morphia in type- 
mania (Krafft-Ebing), in chronic mania, and melancholia. Probably 
the best effects have been witnessed from opium in melancholia. In 
this mental disorder, which is a condition of depression, the best form 
for the administration of opium is the tincture, and the dose required is 
the stimulant and not the narcotic dose. The author is impelled to add 
the caution so well expressed in the following words by Maudsley : "It 
will be well to have in mind that neither opium by the mouth, nor mor- 
phia hypodermically injected, will always quench the fury of acute 
mania, and that successive injections of morphia, followed by brief 
snatches of fitful sleep, have been followed also by fatal collapse." 

It was formerly held that large and increasing doses of opium were 
necessary for the cure of delirium tremens, the theory being entertained 
that to procure sleep was to insure recovery. It is now known that to 
reestablish digestion and to support the powers of life by suitable nutri- 
ents are in a large proportion of cases the only means needed to quiet 
delirium and to cause sleep. Opium, if used at all, must be given cau- 
tiously. Chloral has to a large extent taken its place as an hypnotic in 
this disease, but cases are not unfrequently met with in which morphia 
agrees better, and is more effective in inducing quiet. 

Some cases of sunstroke, coup de soleil, or " thermic fever," are 



436 CEREBRAL SEDATIVES. 

rapidly cured by the hypodermatic injection of morphia. When the pa- 
tient is able to swallow, good effects follow the conjoined administration 
of tincture of opium and brandy. The cases benefited by this treatment 
are characterized by pallor of the face and weakness of the heart. 

Epilepsy and epileptiform seizures may be sometimes prevented by 
the timely administration of morphia hypodermatically. This treatment 
is best adapted to epilepsy, the attacks of which occur at night, to petit 
mat, and to convulsive tic. . It is improper in epileptoid seizures, due 
to tumor or other coarse organic lesion of the brain. In suitable cases, 
this treatment procures most decided amelioration in the condition of 
the patient. 

The remarkable fact has been demonstrated by Loomis, of New 
York, that we have in the hypodermatic injection of morphia the most 
important agent for the cure of urcemic convulsions, puerperal and non- 
puerperal. It is true this mode of treatment had been originally prac- 
tised by Scanzoni, but Loomis has, more especially, drawn attention to 
its real power and utility. " The most uniform effect of morphine so 
administered is, first, to arrest muscular spasms by counteracting the 
effect of the uraemic poison on the nerve centres ; second, to establish 
profuse diaphoresis ; third, to facilitate the action of cathartics and 
diuretics, especially the diuretic action of digitalis." 

In chorea Trousseau has carried the administration of morphia to an 
extraordinary extent. He restricts its use to severe cases, which appear 
to have a singular insusceptibility to the action of opium even in enor- 
mous doses. When the jactitations are incessant, preventing sleep, or 
persisting in spite of sleep, the utility of morphia is very great. It is 
most effective when combined with chloral. In these severe cases of 
chorea, the only limit to the quantity of morphia is the effect produced. 
It is evident, from the experiences of Trousseau, that very large doses 
are required, and that curative effects are thus obtained to which small 
doses are entirely inadequate. The subcutaneous method is more effi- 
cient than the stomach administration. 

In tetanus and hydrophobia the use of morphia has been chiefly pal- 
liative. M. Demarquay has, however, applied morphia, by deep injec- 
tion into the tetanized muscles, with greater success than heretofore. 
He carries the needle deeply into the tetanized muscles, and, if possi- 
ble, to the point of entrance of the nerves. He injects in this way the 
masseters, the sterno-cleido mastoid, the neck and sacro-lumbar muscles, 
etc. The relaxation of the muscles of mastication thus induced per- 
mitted the nourishment of the patients. Of three cases thus treated 
during the siege of Paris two recovered and one died, but the death 
was due to pyaemia and not to tetanus. 

The most important uses of opium, and its various preparations, are 
in the relief of pain. In surgical practice its administration is indis- 
pensable to prevent or mitigate shock, to quiet pain, and to check in- 



OPIUM. 437 

flammation. To particularize on these points would require an epitome 
of surgery for illustration. Before the administration of chloroform 
morphia should be injected hypodermatically, to diminish the dangers 
of the inhalation and to secure relief to the after-pain of the surgical 
' operation. Nothing is more universal in surgical practice than the ad- 
ministration of an opiate after an operation of any magnitude, for the 
objects above named. 

The most signal service is rendered by opium and its preparations 
in the various neuralgias. The most effective mode of administration 
is by subcutaneous injection, and the remedy should be inserted in the 
neighborhood of the affected nerve, notwithstanding that relief is af- 
forded by the injection at any point. In tic-douloureux, brachialgia, 
cardialgia, gastralgia, hepatalgia, nephralgia, sciatica, and pelvic neu-' 
ralgice, immediate relief is afforded by this remedy, and the relief is 
not temporary and palliative merely, but curative in numerous instances. 
It appears to be especially curative in sciatica. It is a remarkable fact 
that morphia inserted under the skin, and especially in the neighbor- 
hood of affected nerves, exerts a curative power which it does not at all 
have when administered by the stomach. An efficient method of using 
morphia in the treatment of neuralgias, according to Brown-Sequard, 
consists in applying it in a finely-divided state to the derma, denuded 
by a blister. Lafargue proposed the method of inoculation, which con- 
sists in inserting morphia into the skin by means of a lancet-puncture. 
These clumsy and painful processes are by no means equal to the hypo- 
dermatic method. 

The enchanting sense of relief to suffering wrought by opiates, and 
especially by the subcutaneous use of morphia, leads to the morphia- 
habit. It is a singular fact that in these cases the pains which were cured 
by the remedy return when it is withdrawn, and other painful sensations 
appear of an even more distressing kind. In practising the hypoder- 
matic method for a long period in severe cases of neuralgia, the utmost 
care should be used to avoid the morphia-habit. 

In the neuroses of the respiratory organs, great relief is often af- 
forded by the use of opium in some of its forms. No remedial agent 
will so quickly cut short a paroxysm of asthma as the hypodermatic 
use of morphia. The paroxysms of difficult breathing, which occur in 
emphysema, are also readily relieved in the same way. But there is 
great danger of establishing the opium-habit in these chronic cases. 
In an allied disease — hay-fever, hay-asthma, or autumnal catarrh — 
the hypodermatic use of morphia is quite as effective as in spasmodic 
asthma. An incipient catarrh may be aborted by a full dose of Do- 
ver's powder, taken at the very outset of the inflammation. Morphia 
and quinia combined are rather more effective than Dover's powder in 
these cases. Opium, or some of its preparations, enter into . the com- 
position of expectorant mixtures to allay cough. 



438 CEREBRAL SEDATIVES. 

The hypodermatic injection of morphia has been shown to possess 
a high degree of utility in cases of dilated heart, with difficult breath- 
ing, and general oedema. The eighth to the sixth of a grain suffices for 
this purpose. The effect it has is to quiet and regulate the action of 
the heart, to allay the distress of breathing, and to permit rest and 
sleep in the recumbent position. An occasional dose only is necessary 
(twice or three times a week). 

Opium is a very important addition to our resources in the treat- 
ment of diabetes. It must be given in considerable doses, as Pavy has 
shown. From six to twelve grains a day are necessary, in order to pro- 
duce a decided impression. It checks the bulimia — the inordinate ap- 
petite — allays thirst, diminishes the flow of urine, and the excretion of 
sugar, and, probably, arrests or prevents the changes in the nervous 
system which accompany or are causative of this disease. Although 
many cases are decidedly ameliorated, it cannot be said that any have 
been cured by opium. 

External Uses op Opium. — A solution of morphia in distilled water 
is an excellent astringent anodyne in conjunctivitis, and, combined with 
atropia, in iritis. !r>. Morphiae sulph., grs. iv — grs. viij ; aquae destik, 
| j. M. Sig. A few drops to be put into the eye as necessary. ]$ . 
Morphias sulphatis, grs. iv ; zinci sulphatis, grs. ij — grs. viij ; atropia? 
sulph., gr. j — grs. ij ; aquas destik, § j. M. Sig. Lotion for iritis and 
other inflammatory affections of the eye. The last formula, omitting 
tfhe zinc, is an excellent application in earache, the external meatus 
being filled with it, and in toothache, a few drops on cotton being placed 
in the hollow of the tooth. 

Local inflammatory swellings, painful in character, can be relieved 
somewhat by poultices containing laudanum. Frictions with laudanum 
are serviceable in lumbago, sciatica, myalgia, and similar superficial 
painful affections. An infusion of opium ( 3 j — O j ), applied hot, is an 
excellent application to inflamed joints, inflamed testicle, etc. 

On the combined Uses op Opium and Belladonna, Moephia and 
Ateopia. — The conjoined use of these agents is so important a subject 
from the point of view of practical therapeutics, that the author pur- 
poses to consider it under this head. Although a physiological antago- 
nism as respects a part of their action unquestionably exists, it does not 
extend throughout their whole range of influence in the organism. The 
balance of actions furthermore produces results which neither is capable 
of singly. Hence the importance of a more direct presentation of these 
points than has been heretofore given. 

Both 'act on the brain, atropia causing delirium, hallucinations, and 
disturbed sleep ; morphia producing stupor, somnolence, hebetude of 
mind. Both relieve pain, but this effect is much greater in the case of 
morphia. Both produce disorders of motility, staggering, difficulty 
of coordination of muscular movements, vertigo, confusion of mind, and 



OPIUM. 430 

headache. The reciprocal influence exerted upon each other, when they 
are administered together, modifies in a remarkable manner their physi- 
ological effects. 

Morphia corrects the illusions and phantasms produced by atropia. 
In small doses (e. g., one ninety-sixth of a grain) atropia increases the 
hypnotic power of morphia, with the result of causing a less disturbed 
and more nearly normal sleep than is produced by morphia alone. If, 
however, the quantity of atropia be in excess of what is necessary to 
establish the physiological balance in the cerebrum, it overrides the 
action of morphia and asserts its own peculiar power of inducing phan- 
tasms, illusions, and hallucinations. 

The pain-relieving power of morphia is rather increased than di- 
minished by atropia. The disorders of motility are enhanced by the 
mutual reactions of the two agents. The after-headache, vertigo, nau- 
sea, and depression of the heart's action caused by morphia, are to a 
large extent prevented by the conjoined administration of atropia. 
When a large quantity of opium, or morphia, is given by any of the 
modes of administration, its immediate depressing effects are counter- 
acted by the simultaneous use of belladonna or atropia. Morphia pro- 
duces contraction of the pupil, and a tetanic condition (according to 
Graefe) of the muscle of accommodation; atropia causes dilatation of the 
pupil, and contraction of the ciliary muscle. When used together these 
effects may be precisely balanced. It requires but a minute quantity 
of atropia to overcome the action of morphia on the pupil. When these 
effects on the pupil are balanced, it does not follow that the muscle of 
accommodation is in a normal condition, for visual defects remain. 
Morphia prevents the contraction of the arterioles produced by atropia, 
and, as a necessary consequence, the subsequent relaxation of the mus- 
cular fibre. 

Morphia depresses the action of the heart, atropia is a powerful car- 
diac stimulant. Morphia produces pallor of the surface, and reduces the 
external temperature ; atropia causes redness and injection of the skin, 
and elevation of the body-heat. In some experiments the author ascer- 
tained that while atropia alone raised the pulse to 105 from 72, atropia 
and morphia combined depressed the pulse of the same subject to 60. 

Both morphia and atropia produce dryness of the mucous membrane 
of the mouth and fauces. Morphia suspends, and atropia increases, the 
peristaltic movements. The sickness and nausea caused by morphia 
are, to a considerable extent, lessened or prevented by atropia. 

Morphia lessens and atropia increases the functional activity of the 
kidneys ; on the skin their effects are opposed, hence when used in 
combination the urinary secretion is rather increased than diminished 
by them. Both produce dysuria. 

Therapeutical Applications of Opium and Belladonna. — When- 
ever opium is used to relieve pain, to procure sleep, to relax spasm — 



440 CEREBRAL SEDATIVES. 

there being no inflammatory action present — belladonna should be com- 
bined with it, unless some contraindication should exist to the action 
of the latter. This formulated expression is more especially applicable 
to the hypodermatic use of morphia. 

In the various psychical disorders, in which the general condition 
is sthenic, opium or morphia should be used alone. When power is 
deficient, the forces depressed, the temperature rather below than above 
the normal, belladonna or atropia should be combined with the opium 
or morphia. For the relief of insomnia the combined action of these 
agents is much more effective than either singly. The proportion in 
which the alkaloids should be used is about as follows : -j-J-g — -j-J-g- of a 
grain of atropia to •£ and £ of a grain of morphia. 

In the various convulsive disorders in which opium or morphia 
may be used, especially hypodermatically, atropia should be combined 
with it. 

The neuralgias are best treated by morphia and atropia combined, 
for the following reasons: the combination is more effective, the after- 
unpleasant effects of either are prevented to a considerable extent. 

The neuroses of the respiratory organs, of the abdominal viscera, 
etc., are, as a rule, more successfully treated by morphia and atropia in 
combination, than by either separately. 

In surgical diseases and operations of various Jcinds, the combina- 
tion of morphia and atropia has most important and varied applications, 
among which may be enumerated: to render safer and to prolong ether 
or chloroform narcosis / to prevent or relieve shock ; to save suffering • 
to relax muscles ; to facilitate operative procedures. 

The combined administration of morphia and atropia is of the great- 
est, service in obstetric practice: to relieve the teasing pains of the first 
stage / to procitre sleep in the course of an exhausting labor ; to quiet 
after-pains ; to facilitate the performance of various obstetric opera- 
tions / to arrest puerperal convulsions. 

Authorities referred to : 

Albers, Dr. J. H. F. Virchow's Archiv, Band xxvi., p. 229. 

Allbutt, Dr. T. C. The Practitioner, vol. iii., p. 342. Ibid., vol. v., p. 327. 

Anstie, Dr. F. E. Stimulants and Narcotics, American edition. Article Alcoholia- 
mus, Reynolds's System of Medicine. The Practitioner, vol. i., No. 1, etc. 

Asche, Dr. Schmidt's Jahrbucher, Band exxv., pp. 331-337. 

Baktholow, Dr. Roberts. Manual of Hypodermic Medication, second edition. 

Bernard, Claude. Bulletin General de Therapeutique, vol. lxxvii., p. 241, et seq. 

Ibid. Archives Generates de Medecine, 1864. 

Bois, De. A. De la Methode des Injections Sous-cutanees, Paris, 1S(?4, p. 17. 

Courtenat, Dr. E. M. West Riding Lunatic Asylum Reports, vol. Li., p. 254. 

Da Costa, Dr. J. M. Pennsylvania Hospital Reports, 1868. 

Demarquay, Dr. Bulletin General de Therapeutique, October 15, 1871, p. 229, et seq. 

Erlenmeyer, Dr. A. Die subcutanen Injeetionen der Arzneimitlel, dritte Auflage, Neu< 
wied, 1866. 



HOPS. 441 

• Eulenburg, Dr. A. Die hypodermatischen Irtjeclionen der Arzneimilkl, zwcite Auflnge, 
Berlin, 1867, p. 96, el seq. 

Ibid. Lehrbueh der functiondlcn Ncrvenkrankheiten, Berlin, 1871, p. 166, etc. 

Fi.uckiger and Hanbury. Pharmacographia, p. 40, et seq. 

Fronmuller, Dr. Klinische Sludien uber die schlafmachende Wirkung der narkolischen 
Arzneimittel, Erlangcn, 1869. 

Harlet, Dr. John. The Old Vegetable Neurotics. 

Hunter, Charles. On the Speedy Relief of Pain and other Nervous Affections by 
means of the Hypodermic Method, Churchill, London, 1865. 

Husemann, Drs. Aug. und Theod. Die Planzenstoffe, p. Ill, et seq. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimitiellehre, Berlin, 1876, 
zweiter Band, p. 1055, et seq. 

Hutchison, Dr. James H. Pennsylvania Hospital Reports. 

Krafft-Ebing, Dr. R. ton. Bulletin General de TherapeUique, January 30, 1870, 
p. 474. 

Lawson, Dr. Henry. Sciatica, Lumbago, and Brachialgia, London, 1872. 

Loomis, Dr. A. L. Lectures on Diseases of the Respiratory Organs, Heart, and Kid- 
neys, New York, 1875, p. 450. 

Maudsley, Dr. H. The Physiology and Pathology of the Nervous System, and Rey 
fields' s System of Medicine. 

Medico-Chirurgical Transactions, vol. 1., p. 561, et seq. 

Mitchell, Dr. S. Weir. American Journal of Medical Science, lS69-'70, also in con. 
junction with Morehouse and Keen. 

Ibid. Injuries of Nerves and their Consequences. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimitiellehre, p. 1, et seq. 

ReisSner, Dr. Bulletin General de Therapeutique, January 30, 1870, p. 89. 

Robertson, Dr. C. Lockhart. The Practitioner, May, 1869, p. 272. 

Rosenthal, M. Klinik der Nervenkrankheiten, Stuttgart, 1875. 

Stille, Dr. Alfred. Epidemic Meningitis, and Tlierapeutics and Materia Medica. 

Taylor, Dr. A. S. On Poisons, third edition,. London, 1875, p. 547. 

Trousseau, A. Clinique Medicate, vol. ii., p. 196. 

Ward, Dr. J. Bywater. West Riding Lunatic Asylum Reports, vol. L, p. 152. 

Wolff, Dr. 0. J. B. Archiv fur Psychiatrie und Nervenkrankheiten, Band ii. 

HumulllS. — Hops. The strobiles of humulus lupulus. 

Lupulina. — Lupuline. " The yellow powder separated from the 
strobiles of H. lupulus." Lupuline, Fr. ; HopfendrUsen, Ger. 

Infusum ZTumuli. — Infusion of hops ( | ss — O j ). Dose, a teacup- 
ful or more. 

Tinctura Humuli. — Tincture of hops (f v — O ij ). Dose, 3 ss — 

3 ij- 

Tinctura Xupulince. — Tincture of lupuline ( 3 ij — O j ). Dose, 3 ss 
— §ss. 

Oleoresina Lupulince. — Oleo-resin of lupuline. Dose, m. v — 3 ss 
or more. 

Extractum Lupulince 1'luidum. — Fluid extract of lupuline. Dose, 
3 ss — 3 ij. 

Coiiposmos'. — Hops contain lupuline (described above), a tannic 
acid, an essential oil composed in part of vcderol, trimethylamine, and 
a liquid volatile alkaloid, lupuline (?). 



442 CEREBRAL SEDATIVES. 

Physiological Actions. — Hops, is an aromatic stomachic tonic, and 
as such promotes the appetite and digestive power. It is slightly astrin- 
gent also. The action of the heart is somewhat increased, the cutane- 
ous circulation excited, and diaphoresis produced. 

In a very slight degree, hops first causes cerebral excitement, followed 
by calm and a disposition to sleep. Experience has shown that it pos- 
sesses some anaphrodisiac property, and lessens the functional activity 
of the testes and the apparatus of erection. 

Thebapy. — As a stomachic tonic hops is quite. as serviceable as 
many more rare and costly medicines. It is useful in atonic dyspep- 
sia, simple flatulent colic, and mild diarrhoeas. 

The power of a hop pillow to quiet the mind and to induce sleep 
seems to be well established, but its influence is, doubtless, largely due 
to imagination and the association of ideas. The tincture of lupuline 
and the oleoresin are useful remedies in mild cases of delirium tre- 
mens. They serve a double purpose — as a stomachic tonic and cerebral 
sedative. A combination of fluid extract or tincture of lupuline and 
tincture of capsicum is probably the best substitute for alcoholic stimu- 
lants, when the habit of their use is to be discontinued. ]J. Ext. lu- 
pulinae fluid., tinct. capsici, aa § j. M. Sig. One or two teaspoonfuls as 
necessary. The condition known as horrors, or the wakefulness and 
excitement which just precede the attack of delirium tremens, may 
often be quite removed by free use of this combination. 

Nocturnal seminal losses may be reduced in frequency by the use 
of lupuline, of which the best preparation for this purpose is the oleo- 
resin. Chordee is said to be prevented by the use of lupuline, but the 
author has been quite disappointed in his attempts to relieve this state 
by this remedy. 

A hop poultice or bag is a domestic remedy for internal pains and 
inflammation, especially of the abdominal organs. A quantity of hops is 
sewed into a muslin bag, dipped in hot water, and then laid over the 
affected region. It forms a light fomentation, which owes its virtues 
rather to the heat and moisture than to the anodyne qualities of the hops. 

Lactucarium. — Lactucarium. " The concrete juice obtained from 
lactuca sativa, by incision and spontaneous evaporation." Dose, gr. 
V— 3 j. 

Syrupus Lactucarii. — Sirup of lactucarium ( 3 j — Oj). Dose, ? ss 

-Ij- 

Composition. — Lactucarium contains several organic substances 
and eight to ten per cent, of inorganic matter. It } j ields about fifty- 
eight per cent, of lactucerine or lactucone, an inodorous, tasteless 
neutral substance, a crystallizable bitter principle, lactucine, and lac- 
tucic acid. 

Physiological Action, ajtd Thekapy. — The soporific quality of let- 



BROMIDES. 443 

tuce is known to all who eat this vegetable. Notwithstanding this uni- 
versal experience, careful experiments have shown that lactucarium pos- 
sesses a very feeble hypnotic quality, if it be not entirely inert. It is only 
used as a substitute for opium and its alkaloids when these disagree. 
The sirup of lactucarium is prescribed to relieve cough, but it is more 
properly employed as a vehicle for more powerful agents of the class of 
expectorants. 

Bromides. — Ammonii Bromidum. Bromide of ammonium. Bro- 
mure d'ammonium, Fr. ; Bromammonium, Ger. " A white, granular 
salt, becoming yellow on exposure, readily soluble in water, and spar- 
ingly so in alcohol." Dose, gr. v — 3 j. 

Botassii Jiromidum. — Bromide of potassium. JBromure de potassi- 
um, Fr. ; Bromkalium, Ger. In white crystals, wholly soluble in water 
(1 to 1£), but sparingly soluble in alcohol (1 to 13). Dose, gr. v — 3 j. 

Sodll Bromidum. — Bromide of sodium (unofficial). Dose, gr. v — 

3j. 

Lithii Bromidum. — Bromide of lithium (unofficial). Dose, gr. v — 

Calcii Bromidum. — Bromide of calcium (unofficial). Dose, gr. v 

-3j- 

Antagonists and Incojipatibles. — Acids, acidulous and metallic 
salts are incompatible with bromides of ammonium and potassium, and 
nitrous ether with the former. The physiological actions of the bro- 
mides are antagonized by cold, digitalis, belladonna, ergot, and other 
agents which energize the vaso-motor nervous system. 

Syneegists. — Opium, chloral, and remedies belonging to the same 
group, promote the action of the bromides on the brain ; and aconite, 
veratrum viride, gelsemium, etc., increase the depressing effect of the 
bromides on the circulatory system. 

Physiological Actions. — The taste of a bromide is bitter and saline. 
In a short time after it is swallowed, the characteristic taste returns to 
the mouth, owing to the outward diffusion of a portion of that admin- 
istered. The tactile sense of the fauces, as also the muscular move- 
ments in the act of swallowing, are diminished by long-continued use 
of the bromides. 

Sixty grains of the bromide of potassium or sodium, and a less 
quantity of the ammonium salt, will, in some persons produce slight 
nausea and diarrhoea ; in others, a sense of coolness in the epigastric 
region ; but in many, provided the salt is properly diluted, no effect on 
the stomach. Gastric catarrh is undoubtedly one of the evil results 
which may follow the protracted administration of the bromides in con- 
siderable doses. 

These are diffusible substances and hence pass quickly into the blood. 
When large doses are administered, it is probable that no inconsider- 



444 CEREBRAL SEDATIVES 

able portion escapes absorption, for they can be detected in the intes- 
tinal mucus and in the faeces. 

Very obvious effects on the action of the heart, on the respiration, 
and on the animal temperature, are produced by the bromides if admin- 
istered in considerable quantity. These functions are depressed, but 
the depression is much less evident as to temperature, hence, in order to 
determine this result most careful observations are necessary. The 
author has ascertained that two drachms of bromide of potassium will 
lower the temperature in a healthy adult from one-fifth to one-half a de- 
gree ; the respirations from two to five, and the pulse from ten to twenty 
beats per minute. These effects are more pronounced in animals, as 
ascertained by the administration of lethal doses. In man the number 
of the cardiac pulsations is not only reduced, but their force is dimin- 
ished, and the tension of the arterial system is lowered. 

A transient excitement, intoxication, giddiness, in some persons an 
anxious mental state, are produced by one or several large doses. As a 
rule, slight somnolence, and sounder and more refreshing sleep result, 
provided no disturbing element intervenes. The pupil is not affected 
in its size and sensibility to luminous impressions, in an adult man by a 
dose of 120 grains. When long continued the hypnotic effect is much 
more pronounced, and a constant drowsiness is experienced. The sensi- 
bility to pain, but especially the sensibility to tactile impressions, is 
lowered by the bromides at all accessible points of the mucous mem- 
brane, and of the skin — notably of the plantar surfaces of the hand and 
foot. The diminution of the sensibility of the mucous membranes is in 
part due to a local action of the salt as it is being eliminated. 

Motility is impaired by the long-continued use of the bromides in 
man, and in animals paralysis of the muscles ensues. If injected into 
the tissues of a limb, paralysis of motion and sensibility begins in that 
member. In man the impaired motility is probably due to other factors 
as well as to the action of the bromides on the muscular tissue, viz., to 
the cutaneous anaesthesia, and to an anaemia of the coordinating centres 
in consequence of which their functional power is lowered. 

A very notable effect of the bromides — chiefly bromide of potas- 
sium — is the diminution of the sexual feeling and of the power of erec- 
tions produced by it. This fact has been established by abundant clini- 
cal evidence. This result is not, however, produced with equal facility 
in all cases, and considerable doses are necessary in any case. 

Prolonged administration of the bromides develops a peculiar state 
to which the term bromism is applied. This condition of chronic poi- 
soning differs from the effects of a few medicinal doses in the extent 
and intensity, but not in the character, of the symptoms. The following 
were the symptoms of bromism, as observed in an epileptic boy, to 
whom two drachms of the bromide of potassium had been administered 
daily for a month : extreme pallor and anaemia, dilated pupils, acne on 



• BROMIDES. 445 

face, forehead, and shoulders ; a fetid, bromine breath ; slow and feeble 
action of the heart; breathlessness, and quickened pulse on slight ex- 
ertion ; cool hands and feet ; a general subjective sense of coldness ; 
movements in walking tremulous and uncertain ; diminution of the tac- 
tile sensibility of both cutaneous annd mucous surfaces ; fauces dry, and 
the reflex movements sluggish ; swallowing somewhat difficult ; anta- 
phrodisia and complete relaxation of the genitals; mind weak, mani- 
fested in silly conduct and unmeaning laughter. 

Various mental symptoms are in some subjects produced by the long- 
continued use of the bromides. Weakness of mind, without perversion 
of intellection, is a very constant result of the continued use of large 
doses. Headache, confusion of mind, and a sort of intoxication, had 
long ago been observed to follow the use of the bromide of potassium 
in even moderate doses (Puche). A form of mental derangement, with 
hallucinations of a melancholic character, has been observed by Ham- 
mond and others. 

The pallor and anaemia of bromism are due to several causes : to the 
diminished action of the heart ; slowness of the capillary circulation, 
and consequent interference in the metamorphosis of tissue ; derange- 
ment of digestion and assimilation in consequence of gastric catarrh ; 
and diminished blood-supply to the cerebro-spinal axis. The disorders 
of voluntary movement, the uncertain gait, the apparent defects of co- 
ordination, are variously explained ; but, they are doubtless made up of 
several factors, of which the cutaneous anaesthesia is the most influen- 
tial. The bromides possess the power to destroy or impair the irrita- 
bility of the motor and sensory nerves, and the contractility of muscle, 
and to these effects must be attributed in part the disorders of volun- 
tary movement noted above. 

It is very obvious that the bromides depress certain organic func- 
tions : they diminish the action of the heart, lower the animal temper- 
ature, and lessen the blood-suppVy to various organs. These results can 
only be accomplished by a sedative influence on the sympathetic system. 
Some very accurate observers have maintained that in this action lies 
all of the physiological power of the bromides (Reynolds, Amory). 

Effects of the Bromides compared. — There is a general corre- 
spondence in the actions of the different bromides. As respects their 
influence on the pulse, body-heat, and respiration, the author's compara- 
tive experiments have demonstrated that these agents stand to each 
other in the following order: bromide of sodium, bromide of lithium, 
bromide of potassium, bromide of ammonium. Very notable differences 
exist between the bromide of ammonium and the others, due, undoubt- 
edly, to the character of the base. 

The author's experiments on animals further demonstrated the fol- 
lowing: bromide of potassium possesses the most toxic power, and 
bromide of sodium the least. The bromide of lithium is first, the bro- 



446 CEREBRAL SEDATIVES. 

mide of sodium second, and the bromide of potassium third, in hypnotio 
power. As respects the influence of these agents severally on the reflex 
faculty of the spina, cord, it may be stated that none of them possess 
the power to abolish the reflex faculty except when administered, in suf- 
ficient quantity to produce lethal effects. Considered from this point 
of view, the bromides may be grouped as follows: bromide of ammo- 
nium, bromide of potassium, bromide of lithium, bromide of sodium. 

The elimination of the bromides takes place through the mucous 
membrane of fauces, intestinal canal, and bronchi, through the skin, but 
chiefly by the kidneys. The rate of elimination varies, but is usually 
slow, several days being occupied in its diffusion outward from the 
blood. . 

Therapy. — In some kinds of vomiting the bromides are most ser- 
viceable. The form of vomiting, to the treatment of which they are 
adapted, is that of cerebral origin ; e. g., the vomiting of cerebral con- 
gestion, sea-sickness, the vomiting of pregnancy, etc. They are con- 
traindicated in all cases of vomiting due to primary gastric disturb- 
ance. 

Remarkable improvement not unfrequently results from the use of 
bromide of potassium in cholera infantum. It is difficult to define the 
precise conditions under which this agent is successful ; but, according 
to the author's observation, it is useless, if not injurious, when defective 
alimentation is the cause of the attacks, and is serviceable just in pro- 
portion to the degree in which an irritable state of the nervous system 
dominates the gastro-enteric disturbance. When the cause of the at- 
tacks is heat, or reflex irritation of the fifth pair as in teething, or cere- 
bral congestion, very excellent results are obtained from the use of the 
bromide of potassium, fy. Potassii bromidi, 3 ij ; syrp. simplicis, § ss ; 
aquae menthas pip., § jss. M. Sig. A teaspoonful every hour or two. 

Increased action of the heart (hyperkinesis) due to irritation of the 
sympathetic, as, for example, such as occurs in exophthalmic goitre, is 
calmed by the bromides. The irregular and too frequent action of the 
heart, occurring in hysterical subjects of plethoric constitution, is gen- 
erally relieved in the same way ; but the bromides are contraindicated 
in all cases dependent on anasmia. Disturbed action (over-action) of 
the heart, with cerebral hyperaemia, is frequently most advantageously 
treated by a combination of digitalis and a bromide : ]J. Inf. digitalis, 
3 iv; potassii bromidi, § ss — § j. M. Sig. A tablespoonful morning 
and, evening. 

Da Costa has, in two distinct publications, strongly urged the use 
of the bromide of ammonium in acute rheumatism. Doubtless, other 
bromides (potassium, sodium, lithium) would be as effective, and are 
certainly much less disagreeable. The author has used the bromide of 
lithium with considerable apparent success, in subacute rheumatism, in 
rheumatic gout, and to remove the stiffness and nodosities of joints re- 






BROMIDES. 447 

maining after attacks of the above-named rheumatic affections. The 
wakefulness, delirium, and hyperpyrexia, which sometimes complicate 
rheumatism and gout, are best treated by bromide of lithium, pain be- 
ing relieved by morphia if necessary. 

It has been stated that the bromides, especially bromide of ammo- 
nium, diminish the deposition and hasten the retrograde metamorpho- 
sis of the fat in obesity. Undoubtedly these agents increase waste, but 
they do so, chiefly, in consequence of a severe gastric catarrh which 
they set up. 

Rabateau has proposed the use of the bromides as eliminating 
agents in cases of mercurial, cupric, or saturnine poisoning. These 
agents, more efficiently than the iodides, combine with the deposited 
minerals, convert them into soluble combinations, and thus cause their 
elimination. The best results are probably obtained by a combination 
of the bromide and iodide of potassium. 

The most important therapeutical applications of the bromides of 
potassium, sodium, lithium, etc., are in the treatment of cerebral disorders 
from over-action. The bromides acting on the heart slow its move- 
ments, and, on the vaso-motor nerves, diminish the intra-cranial blood- 
supply. The best results are obtained in the treatment of cases in 
which there is no anaemia on the one hand, or inflammatory reaction on 
the other ; cases in which the intra-cranial blood-supply is in excess, 
because the vaso-motor regulating centres are wanting in activity. The 
most typical representation of this condition is seen in wakefulness 
from cerebral overwork. No clinical fact is more conspicuous than that 
the bromide of potassium will relieve wakefulness of this kind. The 
hypnotic action of the bromides is not a certain action like that of 
chloral, nor like that of morphia under appropriate conditions ; consid- 
erable mental excitement and an active cerebral congestion may entirely 
prevent the hypnotic effect. Wakefulness from mental worry, fatigue, 
unrest of the peripheral nerves (fidgets), and similar causes, will gen- 
erally be relieved by the bromides. For this purpose a cumulative ac- 
tion is generally desirable, viz., to give a dose of fifteen grains before 
each meal, and one of thirty grains on retiring. The manner in which 
the hypnotic action of the bromides is limited by certain states of the 
intra-cranial circulation is well exhibited in delirium tremens. In the. 
condition of nervous excitement and wakefulness which precedes the 
delirium, and which is known as " horrors," the action of the bromide 
is most satisfactory ; it quiets the restlessness and induces sleep. For 
this purpose considerable doses are necessary — a drachm every four to 
six hours. When, however, delirium tremens is fully developed, this 
remedy is much less efficient, and frequently fails altogether to produce 
sleep. It is more serviceable in the first than in subsequent attacks of 
horrors, and its utility diminishes as the structural alterations of chronio 
alcoholismus increase. 



448 CEREBRAL SEDATIVES. 

In some cases of maniacal excitement the bromides produce excel- 
lent effects, but they very frequently fail without apparent reason. In 
acute mania accompanied by heat of head, injected conjunctivae, and 
restlessness, refreshing sleep may follow the administration of one full 
dose ; but the remedy fails more frequently than it succeeds. In puer- 
peral mania of the sthenic form, with rather quick and full pulse, hot 
head, and injected conjunctivas, the author has witnessed excellent re- 
sults from the use of the bromide of potassium ; but it has rather in- 
creased the delusions and the depression %vhen the type of the case was 
melancholic, with systemic weakness and anaemia. A similar experi- 
ence has been had in the use of the bromides in hypochondriasis and 
melancholia. ■ These forms of mental trouble are most usually accom- 
panied by bodily weakness, and are rather increased by the use of the 
bromides ; but it occasionally happens that these agents give an amount 
of relief afforded by no other drug or combination of drugs. It is im- 
possible to indicate, in the present state of our knowledge, the particu- 
lar cases in which the bromides may be serviceable, but the author vent- 
ures to express the opinion that the state of the intra-cranial circula- 
tion, which may be ascertained on ophthalmoscopic examination, will 
furnish the true guide. It need hardly be observed that the bromides 
are useless when wakefulness is dependent on pain. 

Some kinds of neuralgia are much benefited by the bromides. The 
congestive form of migraine, or sick-headache, is generally quickly dis- 
pelled by one or more full doses. The form of migraine in which it 
acts almost as a specific is that characterized by a flushed face, throb- 
bing temples, injected conjunctivas, eyes intolerant o£ light. The bro- 
mides often give great relief in the fugitive nerve-pain of hysterical 
women ; but they are quite ineffectual in neuralgia fixed in a nerve, as, 
for example, in trigeminal neuralgia, sciatica, etc. The bromide of 
potassium is often quite successful in ovarian neuralgia, and in the 
nervous unrest which grows out of ungratified sexual instinct in men 
and women. 

Very remarkable results have been obtained by the use of large 
doses of bromide of potassium in tetanus. H. C. Wood gives a tabular 
statement of fifteen cases which he has collected, in which the bromide 
of potassium was the chief or the only agent used, and of these but two 
died. No results equal to this have been achieved by any other agent, 
not even by Calabar bean. In order to succeed with this remedy it 
must be given in large doses ( 3 j every three or four hours). 

Cases of strychnia-poisoning have been reported cured by full doses 
of the bromide of potassium. One case is narrated by Dr. Gillespie in 
which three grains of strychnia were taken, and the lethal effects were 
obviated by one ounce of bromide of potassium in divided doses. 

No therapeutical fact is better established than the influence of -bro- 
mide of potassium over epilepsy and epileptiform seizures. But the 



BROMIDES. 449 

curative power of this agent in epilepsy has numerous limitations. It 
has been well ascertained that bromide of potassium is most valuable 
in those cases of epilepsy characterized by frequent and violent con- 
vulsive seizures. Epileptiform attacks, dependent on the presence of a 
tumor or other coarse organic lesion of the brain, are usually suspended 
by the use of this agent, although the neoplasm is unaffected in its 
growth and development. It is a curious circumstance that attacks, 
nocturnal exclusively, are less amenable to the bromide-treatment than 
those which occur in the daytime. 

Cases of the petit mal, or epileptoid seizures, in which there is tem- 
porary loss of consciousness Avithout convulsion, or with a transient 
spasm of the facial muscles, etc., are as a rule not so much benefited as 
are cases of the grand mal. Hysterical convulsions (hystero-epilepsy) 
are benefited by the bromide in the degree in -which they partake of the 
nature of true epilepsy. Simple hysterical convulsions are rarely im- 
proved even by a course of this medicine. It has been repeatedly 
shown, as was first observed by Sir Charles Locock, that the bromides 
are especially efficacious in cases of epilepsy of sexual origin. 

Although the bromide of potassium is less effective in the epilepsy 
of childhood than of adults, it is an excellent remedy in infantile con- 
vulsions dependent on reflex irritation. After the removal of the irrita- 
tion the convulsive attacks may continue, but they can be arrested by 
the use of the bromides. The cerebral congestion which precedes the 
convulsive seizure ma}' be relieved by this agent, and the threatened 
attack averted. The author is convinced that the convulsions which at- 
tend tubercular meningitis may be prevented by the bromide, but this 
agent exerts no curative influence in this fatal malady. 

In the present state of our knowledge it is not possible to indicate 
with any degree of certainty, besides the points mentioned above, the 
kind of cases in which a successful result may be expected from the 
bromide-treatment. If no improvement be manifest after several weeks 
of treatment, and if bromism be induced, the case must be regarded as 
an unfavorable one for this treatment. Brown-Sequard thinks that the 
cropping out of an "acne-like eruption on the face, neck, shoulders," 
etc., is an evidence that the bromide is proving curative, and he even 
asserts that there is " a positive relation between the intensity of the 
eruption and the efficacy of the remedy against epilepsy." According 
to Voisin, the abolition of reflex nausea — ascertained by passing a spoon 
as far back as the epiglottis, without causing attempts at vomiting — is 
an indication of the successful action of the remedy. Furthermore, 
he regards the following physiological effects as evidence of curative 
power: "hypnotic manifestations, general lassitude, an easy and rapid 
disappearance of reflex nausea, and antaphrodisiac action." 

Certain cases of epilepsy, in which the bromide of potassium fails to 
afford relief, are greatly benefited by strychnia. From this circum- 
30 



450 CEREBRAL SEDATIVES. 

stance it has been concluded that the former agent is most serviceable 
in cases in which a condition of hyperaemia of the brain exists, and 
that the latter agent produces the best effects when a condition of 
cerebral anaemia is present. 

Various important considerations are connected with the adminis- 
tration of the bromides in epilepsj'. The daily dose required varies from 
half a drachm to four drachms, the limit of the quantity administered 
being determined by the effect produced. The occurrence of bromism 
and the arrest of the seizures are the evidences that a sufficient quan- 
tity has been introduced into the organism. According to the author's 
experience, forty grains of the bromide, dissolved in water and given 
before each meal, or three times a da} r , and if required a double dose at 
bedtime, is an amount of the medicine which it is rarely necessary to 
exceed. When the convulsive attacks have ceased, a single dose of 
sixty grains at bedtime will generally suffice ; but this result must not 
be interpreted too favorably, and the remedy discontinued, for an im- 
mense experience has now demonstrated that security against a return 
of the attacks can only be attained by a continuance of the remedy for 
two or more years after all indications of epilepsy have disappeared. 
After the continuous use nightly of the remedy for a year, the dose 
may be so far diminished as to give it on alternate nights. Should the 
attacks recur after temporary cessation, larger doses are required as 
a rule. 

The long-continued use of the bromide of potassium may produce 
very serious symptoms of bromism. The remedy must then be discon- 
tinued, and tonics and restoratives administered until the organism 
recovers its tone. It is not unfrequently desirable to administer iron 
during a course of bromides. The author has had excellent results from 
the following : ]J . Potassii bromidi, § j ; ferri bromidi, gr. vj ; aquae, 
§ vj. M. Sig. A tablespoonful three times a day. Echeverria has 
made the observation that taking strong coffee with the meals hinders 
the development of bromism. The troublesome and very disfiguring 
acne may be, in part at least, prevented by the conjoined administra- 
tion of arsenic (three to five drops of liq. potassii arsenitis). Brown- 
Sequard, with that fondness for complex combinations which he has 
always exhibited, recommends the following formula for epilepsy: ]J. 
Potassii bromidi, 3 j ; ammonii bromidi, 3 ijss ; potassii iodidi, 3 j ; po- 
tassii bicarb., 3ij; infus. calumbse, § vj. M. Sig. A teaspoonful 
before each meal, and three teaspoonfuls at bedtime. There is prob- 
ably no advantage in this combination, and it is execrable as regards 
taste. It is true sometimes better results are obtained from a combi- 
nation of bromides than from the bromide of potassium alone. It is 
always advisable to combine the iodide of potassium with the bromides, 
when there is reason to suspect syphilitic cerebral lesions, or when de- 
generate changes may appear to be taking place. 



BROMIDES. 451 

Vaso-motor disturbances, elsewhere than intra-cranial, are relieved 
by the bromides. " Such symptoms are, for example, sudden numbness, 
coldness, deadness, or pricking sensations in one or more limbs ; sud- 
den distressing' but indefinable feelings in the epigastrium, abdomen, 
or hypogastrium ; or sensations akin to rigor, with much anxiety and 
palpitation, or ' fluttering,' of the heart. In such cases it may be ob- 
served that the local circulation is interfered with ; that, for example, 
the pulse in one arm becomes faltering, irregular in force and rhythm, 
occasionally intermitting, while that in the other arm may remain un- 
altered, and the beat of the heart may maintain its normal character." 

The painful flushings of the face, and the sense of fullness in the 
head, which occur so frequently at the climacteric period in women, 
may often be removed by the bromides. 

Certain of the respiratory neuroses are greatly relieved by the 
bromides. Laryngismics stridulus, when present, may be suspended 
by the prompt use of full doses, and the tendency to frequent recur- 
rence of the attacks obviated by the steady and continued use of mod- 
erate doses of this remedy. It may be combined with chloral: IJ. 
Potassii bromidi, 3 ij ; chloral, hydratis, 3 ss ; syrp. tolu., f ss ; aquae, 
3 jss. M. Sig. A teaspoonful every half-hour. The bromides greatly 
relieve the spasmodic element of whooping-cough, but they do not ap- 
pear to shorten the duration of the disease. A combination such a3 
given above, for a child of two years, may be prescribed in whooping- 
cough during the spasmodic stage, and in proportionally larger quantity 
for older children. 

In spasmodic asthma very great relief is sometimes afforded by the 
use of bromides, but these remedies lose their effect very quickly. The 
best results are obtained from a combination of the bromide with the 
iodide of potassium: I£. Potassii bromidi, ^j; potassii iodidi, |ss; 
aquse, § iv. M. Sig. A. teaspoonful in sufficient water every half- 
hour, or hour. 

Cough which is merely reflex (stomachal, intestinal, renal, uterine, 
ovarian) can usually be cured by the bromides. It is said that a gargle 
of the bromide of potassium will diminish the cough of phthisis. The 
author has ascertained that it is only occasionally that such a fortunate 
result can be achieved in this way. Such a diminution of the sensi 
bility of the fauces can be produced by a few large doses of the bromide 
of potassium, that this expedient has been proposed to facilitate laryn- 
goscopy and rhinoscopy. 

In certain neuroses of the genito-urinary organs, male and female, 
excellent results have been obtained by the use of the bromide of potas- 
sium. Abnormal sexual excitement and nocturnal seminal emissions 
may be checked by this remedy. The condition of plethora is the indi- 
cation for the bromide. When the sexual organs are much relaxed, the 
erections feeble, and the seminal fluid watery, especially if there be such 



452 CEREBRAL SEDATIVES. 

a constant stillicidium of semen as to constitute the so-called diurnal 
losses, the bromide of potassium does harm. The more nearly noctur- 
nal seminal losses approach the physiological type, the more effective 
the bromides. As they act by diminishing the blood-supply to the 
erectile organs, it is obvious that they are contraindicated when there 
is debility, and when the erections are feeble. They prove completely 
successful when the erections are normal as to character, but teasing 
and persistent. The various nervous disturbances growing out of un- 
satisfied sexual desire are quieted by these agents. As a rule, nympho- 
mania and satyriasis dependent on cerebral lesions are not diminished 
or prevented by the bromides. 

Bromide of potassium, in full doses, has been proposed for the relief 
of chordee. The result is generally disappointing, but occasionally re- 
lief is experienced from it. Very large doses ( 3 j every four hours) are 
necessary. 

Menorrhagia, dependent on ovarian irritation, is usually promptly 
arrested by these agents. Sometimes metrorrhagia, even when due to 
a fibroid, is remarkably improved by their use, but success is only occa- 
sional, and no precise indications can be laid down. 

Various functional nervous disorders associated with, or dependent 
on, derangements of the sexual system — for example, such as are 
grouped together under the term spinal irritation — are treated with 
success by the bromides. It is to be noted, however, that a condition 
of general anaemia or local spinal anaemia, which usually coexists, is a 
contraindication to the use of these agents. They are useful in propor- 
tion to the degree of plethora present. 

Authorities referred to : 

Anstie, Dr. F. E. Neuralgia and the Diseases that resemble it, English edition, p. 1S5. 

Bartholow, Dr. R. The Bromides: their Physiological Effects and Therapeutical 
Uses, Fisk-Fund Prize, Providence, 1S71. 

Bill, Dr. J. H. American Journal of the Medical Sciences, July, 1868. 

Browne, Dr. J. C. The Action of the Bromide of Potassium on the Nervous System 
Pamphlet. 

Brown-Sequard, Dr. C. E. Functional Nervous Affections, Part i., p. 35. 

Clarke and Amory. The Physiological and Therapeutical Action of the Bromide of 
Potassium and the Bromide of Ammonium, Boston, 1872. 

Da Costa, Dr. J. M. American Journal of the Medical Sciences, April, 1871. 

Damoureite et Peltet. Bulletin General de Therapeutique, vol. Lsiii., p. 296. 

Day, Dr. Albert. Methomania, Boston, 1867, p. 30. 

Echeyerria, M. Gonzales. On Epilepsy, p. 316. 

Eulenburg cnd Guttmann. Schmidt's Jahrbucher dcr gesammten Medicin, voL cxxxvii., 
p. 158. 

Gillespie, Dr. Charles. American Journal of the Medical Sciences, October, 1S70. 

Hammond, Dr. William A. On Wakefulness. 

Ibid. The Psychological Journal. 

Laborde, Dr. J. V. Archives de Physiologie Normale et Pathologique, May, 1868. 

Lewizky, aus Kasan. Virchow's Archiv fur patholog.ische Anatomie, 1S68, p. 183. 



CONIUM. 458 

Pletzer, M. Schmidt's Jahrbiieher der gtaammttn Median, Hand cxxxix., p. ICC, No. 
8, 1868. 

Raduteau, M. Gazette Uebdomadaire, March 19, 1868. 

Reynolds, Dr. J. Russell. The Practitioner, July, 1868. 

Voisin, A. Bulletin General de Therapcutiquc, vol. lxxi., p. 102. 

WILLIAMS, Dr. S. W. D. On the Efficacy of the Bromide of Potassium in Epilepsy, 
etc., Churchill, 1865. 



AGENTS WHICH DEPRESS THE MOTOR FUNCTIONS 
OF THE SPINAL CORD AND SYMPATHETIC. 

Conium. — Hemlock. Cigu'e, Fr. ; Schierling, Ger. 

Conii Folia. — The leaves of conium maculatum. 

Conii Fructus. — " The full-grown fruit of conium maculatum, gath- 
ered -while yet green and carefully dried." 

Extr actum Conii. — Extract of conium. Dose, gr. j — 3 j. 

Extraction Conii Alcoholicum. — Alcoholic extract of conium. Dose, 
gr. j— grs. v. 

Extractum Conii Fructus Fluidum. — Fluid extract of conium-seed. 
Dose, m. ij — m. v — m. xl. 

Succus Conii. — Juice of conium. Dose, 3 ss — 3 j. 

The preparations of conium are very uncertain in strength. It is 
pretty well established that the extracts are nearly, if not quite, inert. 
The best preparations are the fluid extract and the succus. 

Composition. — The special powers of hemlock are due to a peculiar 
alkaloid {conia). This is an oily, limpid liquid, having a strong alka- 
line reaction, a peculiar odor resembling the urine of mice, and a specific 
gravity of 0.88. It probably exists in the plant in the form of the 
malate ; but, by some authorities, the acid with which it is combined is 
supposed to be an acid peculiar to conium, the coneic acid. Conia 
is associated with ammonia, and another crystallizable alkaloid, con- 
hydrine. 

Conia is quickly decomposed by heat. Exposed to the air it is soon 
converted into a brownish resin, and becomes inert. Hence it is that 
the preparations of conium possess but little activity, and are so fre- 
quently, indeed entirely, wanting in physiological and therapeutical 
effects. It is better, therefore, to administer the alkaloid, which, being 
soluble in alcohol, may be administered in that menstruum, or it may 
be converted into an acetate and dissolved in a mixture of alcohol-and- 
water. It is to be noted, also, that different specimens of conia differ 
remarkably in activity; hence whenever a new preparation is begun, the 
minimum dose should be first administered until its real power is ascer- 
tained (Burman). 

Conia. — Dose, gr. -fa — gr. -£§— gr. -fa, or in minim-doses from m. Jg 



454 ' MOTOR DEPRESSANTS. 

— m. ij. Half a minim of conia (pure) is about equivalent in activity 
to § j of the best succus conii. 

Antagonists and Incompattbles — The caustic alkalies and tannic 
acid are chemically incompatible. Physiologically considered, the ac- 
tions of conium are antagonized by nux-vomica and its alkaloids strych- 
nia and brucia, by picrotoxine, and the tetanizing agents in general. 

Synergists. — Gelsemium, tobacco, veratrum viride, aconite, methyl- 
strychnium, hydrocyanic acid, and opium, increase the action of conium. 

Physiological Actions. — The preparations of conium possess a con- 
siderable degree of acridity, and are therefore apt to produce gastric 
irritation, nausea, and vomiting. These results sometimes follow the 
subcutaneous injection of conia. The active principles readily diffuse 
into the blood. What changes, if any, they induce in the blood are 
quite unknown. It is probable that they limit the power of the red 
blood-globules to convey oxygen to the tissues on which they have a 
selective action — the motor nerves. 

When an active dose of conia is administered, weakness of the legs 
and a sense of weight and fatigue of these members are first experi- 
enced. The eyelids become heavy and droop -somewhat, and double 
vision, or confused vision, a feeling of torpor of the mind, and giddi- 
ness, follow. Speech is also affected as respects vocal utterance, but 
the memory for words and the faculties of mind generally are unim- 
paired. When the dose is a lethal one, paralysis of the voluntary mus- 
cles — first of the inferior extremities — ensues, there is considerable ver- 
tigo, the mind is torpid and indifferent but not perverted, speech and 
vision are lost, the respiration becomes labored and slow from parahysis 
of the respiratory muscles, and death occurs from asphyxia, the action 
of the heart continuing until after respiration has ceased. The mind 
remains unclouded to the last, except when delirium ensues from car- 
bonic-acid poisoning. Convulsive movements generally occur in ani- 
mals from retention of carbonic acid in the blood, and in man sometimes 
local convulsive movements. Sensation is unaffected until near the 
close, but a subjective sense of numbness is experienced in the feet and 
legs, without actual impairment of the functions of the sensory nerves. 
The body temperature is decidedly lowered, and in a direct ratio to the 
amount of the paralysis. 

The physiological effects of conia, even when produced by decidedly 
large medicinal doses, are hindered if not entirely prevented by active 
exercise. When the muscular weakness, the heaviness and sense of 
fatigue in the legs are first experienced, if resisted and muscular move- 
ments are carried on, these sensations disappear, and the whole duration 
of the physiological effects is much shortened. 

The action of conia is, primarily and chiefly, on the end-organs of 
the motor nerves ; the nerve-trunks next lose their excitability, and by 
an extension of the paralysis the spinal cord is at last involved. The 



CONIUM. 465 

muscular irritability remains unaffected. According to M. Vcrigo, the 
paralysis proceeds from the spinal cord, outwardly, to the terminal fila- 
ments of the motor nerves. But it is probable that this experimenter 
operated with a preparation of conia containing methyl-conium, which 
has been shown, by (Drum Brown and Fraser, to affect first the motor 
columns of the sj:>inal cord. 

No constant and characteristic post-mortem appearances seem to 
be produced by conia. The left cavities of the heart are found empty, 
and the right distended, but these are products of the mode of dying, 
and are not directly due to the action of the poison. The blood is gen- 
erally fluid, and the coagula are soft. 

Elimination takes place by various channels, chiefly by the kidneys. 
Conia has been found in considerable quantity in the liver, lungs, and 
spleen. 

Therapy. — Formerly the preparations of conium were much used 
for a supposed discutient or resolvent action in glandular enlargements, 
and in certain hinds of tumors. But, since it has been shown that the 
preparation chiefly employed for this purpose (the extract) is practically 
inert, the supposed cures effected in this way are justly regarded as ex- 
amples of the post hoc. Influenced by the same considerations, conium 
was supposed to have an alterant and anodyne action in cancer. But, 
since, in the progress of physiological research, it has been shown that 
conium affects the motor and not the sensory nerves, it is no longer em- 
ployed to relieve the pains, or to arrest the growth and diffusion, of 
cancer. It is right to add, however, that able practitioners hold that 
the discutient and resolvent powers of conium are well established in 
clinical experience (Stills). 

The true uses of conium are those deduced from a consideration of 
its physiological actions. As it lowers the functional activity of the 
motor nervous system, it is indicated in those cases of disease in which 
motor activity is in excess. Very valuable results have been obtained 
by the use of conia in mania, administered with the view of subduing 
excessive motor excitement. Its real utility consists in quieting mus- 
cular agitation, and thus preventing emaciation and maniacal exhaus- 
tion. It is considered to be most suitable to the treatment of acute 
mania, without organic brain-lesion (Burman). The dose required for 
this purpose is m. ss — m. iij, or subcutaneously, commencing with one- 
tenth of a minim, and gradually increasing it until some characteristic 
physiological effects are produced. 

The succus conii has been used by Harley and others with success 
in chorea. The special object for which it is used in this malady is to 
quiet the excessive muscular agitation ; but, in order to accomplish this 
result, a sufficient quantity must be administered to produce distinct 
physiological effects. To quiet muscular agitation is not alone suf- 
ficient to cure chorea; a suitable hygiene, proper alimentation, and 



456 MOTOR DEPRESSANTS. 

restorative agents, are indispensable. Some cases of paralysis agitans 
are remarkably benefited by conium (succus), but it is of little avail 
in cases of sclerosis, or when important structural alterations have 
occurred. Conia is certainly indicated in tetanus, hydrophobia, and 
strychnia-poisoning, but hitherto it has not succeeded, probably be- 
cause inert preparations were employed. The author has ascertained 
that in animals conia rather hastens than retards the lethal effects of 
strychnia. 

In whooping-cough, asthma, and laryngismus stridulus, good effects 
have been obtained by the use of conium, carried to the point of induc- 
ing its characteristic physiological effects. A priori, the best results 
might be ^expected from the use of conium in epilepsy, but it is by no 
means comparable to the bromides. According to Echeverria, conium 
is serviceable in those cases of epilepsy " attended by cerebral derange- 
ment and vertigo." 

The state of blepharospasm, which accompanies strumous ophthal- 
mia, is relieved by considerable doses of conium. It is necessary in the 
treatment of this, as of other motor disorders, to give a sufficient quan- 
tity of conium to produce sensible physiological effects. 

The Hypodermatic Use oe Co:nta. — The alkaloid itself is much too 
irritant for subcutaneous use. The local inflammation which it sets up 
prevents absorption, and hence the effects are nil. The alcoholic solu- 
tion is almost equally objectionable. The following formula, proposed 
by Burman, is best adapted to subcutaneous use : 

5 • Conise, 3 hj, m. xij. 

Acidi acetic, fort., 3 iij, m. xij. 
Spts. vini rect., 3 j- 
Aquaa destillatse ad § ij. 
M. Sig. Dose, one minim to begin with, and gradually increase as necessary. 
Five minims of this solution contain one minim of conia. 

"The acid must be added carefully and gradually until neutraliza 
tion, or as near an approach to it as possible, is attained ; litmus-paper 
being used, from time to time, to determine the reaction." Different- 
specimens of conia may require somewhat different proportions of acid 
to neutralize it. If the mixture be turbid after the addition of the 
spirit and water, a little more spirit may be added. 

The subcutaneous injection of conia may be practised instead of the 
stomach administration, in all of the forms of disease for which this 
remedy is prescribed. By Burman this mode of administration has 
been practised with much success in the treatment of acute mania / by 
Pletzer, in asthma / by Erlenmeyer, in emphysema and angina pecto- 
ris / by Lorent, in pneumonia and pleuritis / and by Eulenburg, in 
blepharospasm. A marked decrease in the pulse-rate, and in the tem- 
perature, has been observed to follow the hypodermatic injection of 



CURARA. 457 

conia in these diseases. The rational indication for the use of conia in 
pneumonia and pleuritis is, to give the organs physiological rest by 
inducing a paretic state of the respiratory muscles. 

Conia and MoRrniA. — The effects of conia are in every way height- 
ened by morphia. These agents have been very successfully employed 
in acute mania, conjointly administered subcutaneously. " Conia act- 
ing on the purely motor centres, in a sedative manner, and morphia 
acting in a similar way on the sensori-motor and ideo-motor centres, it 
follows, as a fair corollary, that the combination of the two, in subcu- 
taneous injection, should lead to effects directly antagonistic to the 
condition of maniacal excitement; and, such being in fact the case, they 
may be thus used together with very great success in the treatment of 
mania." When nerve-pain and muscular spasm coexist, the best re- 
sults may be expected from the combined administration of morphia 
and conia. 

Authorities referred to : 

Burman, Dr. J. Wilkie. West Riding Lunatic Asylum Reports, vol. ii., p. 1. 
Curtis, Dr. Edward. The Medical Record, Nos. ccxxxvii., ccxxxviii., 1875. 
Erlenmeyer, Dr. A. Die subcutanen Injectionen, p. 74. 
Eulenburg, Dr. A. Die hypodermatische Injection, p. 239. 
Fluckiger and Hanbury. Pharmacographia, p. 266. 
Harlet, Dr. John. Old Vegetable Neurotics, English edition, etc. 
Husemann, Dr. Theodor. Handbuch der gesammlen Arzneimittellehre, zweiter Band, 
0. 925. 

Husemann, Drs. TriEOD. und Aug. Die Pflanzenstoffe. 

Kolliker, Prof. Dr. A. Virchow's Arehiv, Band x., p. 228. 

Lorent, Dr. E. Die Hypodermaiischen Injectionen, p. 42. 

Pelvet et Damourette. Archives Generates, sixieme serie, tome vi., p. 87. 

Peltzer, M. Quoted by Eulenburg, supra. 

Taylor, Dr. A. S. On Poisons, third edition, p. 731. 

Von Praag, L. Schmidt's Jahrbilcher der gesammlen Medicin. 

Verigo, M. The Practitioner, vol. vii., p. 58. 

Curara, or Woorara. 

History.— There are no official preparations. The substances 
known under this name, vary much in purity, and differ in origin. 
True curara is a poisonous substance, prepared by the Indian tribes of 
certain districts of South America, and known under the names woorara, 
urari, wurali, etc. A specimen examined by Mitchell and Hammond con- 
sisted of two distinct preparations named respectively carroval and vao, 
the former more closely corresponding to the European specimens. Cu- 
rara is obtained for the most part from several plants of the Strychnos 
family, as Strychnos toxifera, S. cogens, and from Paulinia cururic. An 
extract from these plants, it is supposed, is mixed with the venom of 
certain poisonous reptiles, and possibly with other animal substances. 
As the arrow-poison of different tribes differs not only in strength, but 



458 MOTOR DEPRESSANTS. 

in the character of the effects produced hy them, it is certain that they 
are derived from different sources. That which is now ohtained in 
commerce as curara, and which agrees in the main with the description 
of Bernard, is the substance referred to in this article. 

Composition. — Curara occurs in small, irregular masses, of a dark- 
brownish color, somewhat slimy, and looking like a dried vegetable ex- 
tract. The mass is in part soluble in water, and the undissolved resi- 
due is composed, for the most part, of starch-granules, vegetable cells, 
oil-drops, and other vegetable structures (Mitchell and Hammond). 
The existence of an alkaloid in curara had been suspected by Boussin- 
gault, but it was not actually discovered until 1865, when it was iso- 
lated by Preyer. The estimates formed of its activity vary : by 
Preyer it was held to be twenty times stronger than the crude drug, 
but by Beigel only six times ; but these differences are readily ac- 
counted for in the varying qualities and activity of curara. 

Curarine, the alkaloid, is crystallizable, deliquescent, and forms with 
acids, salts, which are also crystallizable. The dose will range from 
tw S r - *° A" S T - by the stomach — from -^-g- gr. to -j-J-g- gr. when ad- 
ministered subcutaneously. A larger quantity may be necessary when 
distinct physiological effects are to be produced. 

Mitchell and Hammond give the name carrovcdia to the alkaloid 
which they obtained from carroval. 

The dose of woorara or curara, the crude drug, will range from ^ 
gr. to \ gr. It is desirable to try on some inferior animal the activity 
of any new specimen before using it on man. 

Antagonists and Incompatibles. — As curara is a paralyzer, it is 
antagonized by those agents which act in the opposite manner on the 
spinal cord. From the physiological standpoint, strychnia and atropia 
are appropriate antagonists, opposing the tendency to death by failure 
of respiration. Remarkable results have been obtained in animals by 
artificial respiration. An animal will recover from twice the fatal 
quantity, if respiration be kept up until elimination occurs, which is 
speedy. As in the case of the other alkaloids, curarine is destroyed by 
the caustic alkalies. 

Synergists. — The paralyzers in general, especially the respiratory 
group, promote all of the actions of curara. 

Physiological Actions. — The taste of curara is bitter. Applied 
to the unbroken integument it is not absorbed ; but swallowed it slow- 
ly diffuses into the blood, and produces characteristic effects. Vulpian 
finds that it is absorbed more rapidly when injected into muscular 
masses than when simply thrown under the skin. According to the 
observations of Voisin and Liouville, made on man, the salivary, nasal, 
and lachrymal secretions are increased. It is probable that the gastro- 
intestinal secretions are also promoted. The rate of diffusion into the 
veins from the stomach varies, but it takes place in from twenty min- 



CURARA. 459 

utes to a half-hour ; but even a longer time than this may be required. 
The action of the heart increases ; the pulse rises a number of beats 
and may be dicrotic ; the temperature ascends two to three and a half 
degrees, and the respirations are accelerated, four to eight times per 
minute being added to the usual rate. Voisin and Liouville ventured 
on the exhibition of larger doses with the following result : the symp- 
toms began by a more or less violent chill ; the heart beat rapidly, 
reaching 140, and the pulse became weak ; the respiration was labored 
and sighing ; the temperature rose, and double vision, sometimes with 
mydriasis, sometimes with myosis, set in. The legs became weak, co- 
ordination was destroyed, and the vertical position could not be main- 
tained. The mind continued undisturbed. The paralysis disappeared 
after a short time, but a sense of fatigue persisted in the limbs for 
some hours. The increased temperature was accompanied by the 
usual symptoms of fever — there were, besides the accelerated pulse 
and respiration, headache, thirst, and perspiration. 

It was by means of curara that Bernard demonstrated the exist- 
ence of contractility as an independent endowment of muscular tissue. 
Curara, by poisoning the end-organs of the nerves in the muscles, sepa- 
rated these organs, and thus permitted a study of the agency of each. 
In all classes of animals as in man, curara induces paralysis of move- 
ments : locomotion, the erect posture, breathing, finally the heart's ac- 
tion, are arrested. The paralysis induced by curara is not due to an 
abolition of the excitability proper to the motor nerve-trunks, but to a 
modification set up in the terminals of the intra-muscular nerves. This 
fact is proved by the well-known experiment of Bernard, repeated by 
Kolliker, Zeleuski, Vulpian, and numerous other experimentalists, in 
which a frog is paralyzed by curara in all parts of the body except 
one limb which has been ligatured to prevent the access of the poison 
to it. The muscles of the unpoisoned limb react normally to stimula- 
tion, to the will, and to reflex impressions from distant parts. The 
muscles of the poisoned parts of the body act on direct stimulation, 
but not by the will nor by any direct or reflex excitation conveyed by 
the nerve. The paralysis must therefore be due, as above stated, to 
the effect of the poison on the terminals of the nerve in the muscular 
tissue. As movements can be induced in the muscles of the unpoi- 
soned limb, by irritation of the skin at a distant point, it is clear that 
the sensory nerves and the reflex function of the spinal cord continue 
active. It has been abundantly demonstrated that in curarized ani- 
mals the spinal cord preserves its functions for a long time. If, how- 
ever, a large quantity of the poison is administered, and a fatal result 
prevented by artificial respiration, the excitability of the cord is at first 
increased but afterward paralyzed (Von Bezold, Vulpian, etc.). The 
motor and sensory nerve-trunks are also finally affected, but this is a 
secondary action, and ascertainable in curarized animals only by main- 



460 MOTOR DEPRESSANTS. 

taining artificial respiration a sufficient length of time. It follows, then, 
that all parts of the nervous system are ultimately paralyzed. The 
action begins in the end-organs of the motor nerves, and then grad- 
ually extends to all parts, if the dose is large enough and life is main- 
tained by artificial respiration. 

Curara also acts on the accelerator nerves of the heart, at first stim- 
ulating and afterward paralyzing them. The action of the heart is 
increased, also, by the paralyzing effect of curara on the terminals of 
the pneumogastric, thus removing the inhibition. So decidedly is the 
vagus affected by full doses of curara, that galvanic irritation does not 
arrest the movements of the heart (Von Bezold). Notwithstanding 
the increased action of the heart, the blood-pi-essure is lowered by cu- 
rara, due doubtless to a paralyzing action on the organic muscular fibre 
and consequent dilatation of the vessels. The effect of curara on the 
sympathetic is variously interpreted. According to Vuljrian the iris 
contracts on changes in the amount of light falling on the retina in 
curarized animals ; the pupils dilate on faradization of the skin ; dila- 
tation of the vessels of the posterior members and an elevation of tem- 
perature take place in a curarized dog on faradizing the central portion 
of the corresponding sciatic ; very energetic reflex contractions of the 
stomach, intestines, and bladder, are obtained in curarized animals by 
faradizing the skin of different regions of the body (Vulpian). These 
facts indicate that curara does not destroy but rather stimulates the 
functions of the sympathetic. Curara acts on the lymph-vessels of 
frogs. According to Tarchanoff, the liquid which accumulates during 
curarization grows richer in leucocytes ; also the blood contained in 
the vessels becomes more concentrated, the relative proportion of red 
globules being increased. As the accumulation of leucocytes takes 
place in the lymph-sacs, there is a corresponding diminution of them 
in the blood. These changes are due to the paralysis of the peripheric 
vessels (Tarchanoff). 

Curara, as has been stated, produces an obvious rise of temperature 
in the extremities. This is supposed to be due to paralysis of the pe- 
ripheral vessels. In the interior of the body, however, there ensues an 
equally constant decline of body-heat (Tscheschichin, Rohrig und 
Zuntz). This lowering of the central temperature is due to the loss of 
heat at the periphery by the cooling of the blood detained in the su- 
perficial vessels. 

Bernard Ions: ago ascertained that curarized animals became dia- 
betic. It seems probable that this result is due to the paralysis of the 
vessels of the liver. On the other hand, Bock and Hoffmann have ap- 
parently demonstrated that the production of glycosuria is the result 
of increased activity of the liver. It may be due to the fact that the 
sugar formed does not undergo oxidization, for Jolyet has ascertained 
that in curarized animals the excretion of carbonic acid is much below 



CURARA. 4G1 

the amount in health. By reason of the changes in the vascular 
supply, ourara affects the functional activity of various organs. 
The increased production of saliva, and of the nasal and intestinal 
secretions noted at the outset, is due, there is little doubt, to this 
fact. 

The elimination of ourara takes place chiefly by the kidneys, but 
sonic escapes with the faeces (Koch). The urine of a curarized animal 
will poison another animal, and this may be repeated to several sub- 
jects. The retention of the urine oharged with ourara, in the bladder, 
will continue the effects of the poison by reabsorption. This statement 
has been the subject of considerable controversy. It has been denied 
that the mucous membrane of the bladder possesses the power to ab- 
sorb again into the circulation poisons dissolved in the urine in the 
process of excretion. Brown-Sequard appears to have been the first 
to prove, by direct experiment, that alkaloids could be thus absorbed, 
and some recent observations have confirmed the accuracy of his ex- 
periments. In respect to curara, as to other organic alkaloids, when 
poisoning occurs, it is an obviously proper expedient to keep the blad- 
der empty, if necessary, by catheterization. 

Therapy. — The applications of curara to the treatment of disease, 
follow from the results of the physiological study. Being a motor and 
not a sensory paralyzer, it is adapted to the treatment of muscular 
cramp and spasm. It is one of the remedies employed against strych- 
nia-poisoning, and although from the theoretical standpoint such treat- 
ment may seem proper, yet in actual practice it has not succeeded. 
That a remedy obtained from members of the strychnos family, and a 
paralyzer in action, should antagonize strychnia, is a remarkable fact. 
In the process of preparation employed by the Indians, it is in a high 
degree probable that methyl stryehnium is formed, and this substance, 
as was originally shown by Crum-Brown and Fraser, is a paralyzer, 
and acts precisely like curara. Curara has been used with a limited 
measure of success in tetanus. In the successful cases — for exauqjle, 
that narrated by Mr. Spencer Wells — large doses were administered. 
According to the statistics of Demme, of twenty-two cases of tetanus 
treated by this agent, eight recovei'ed. Other methods have certainly 
succeeded better. Two cases of hydrophobia have been reported in 
which a cure followed the use of curara. One of these, reported by 
Dr. Watson, was examined, and the diagnosis confirmed by Dr. Flint, 
of New York. The first dose was -fa gr. and subsequently \ gr. and £ 
gr. were given. The value of this statement is impaired by the fact 
that the different specimens vary so much in activity. M. Vella has 
successfully treated a case of tetanus by cutaneous absorption of the 
agent ; but the usual mode of administration has consisted in the sub- 
cutaneous injection. This subject, as M. Vulpian has well said, has 
lost its interest, since the discovery of the utility of chloral. It is in 



462 MOTOR DEPRESSANTS. 

a high degree probable, however, that curara 'would be greatly more 
successful if it were pushed in these cases to obtain its full physiologi- 
cal influence, and the complete suspension of the spasms. 

By Voisin and Liouville curara has been extensively employed as a 
remedy for epilepsy. The facts already mentioned in regard to the 
action of this agent in producing febrile phenomena were obtained from 
the experiences with epileptics. They find that attacks may be pre- 
vented, and the condition of epileptics much improved, by the timely 
administration of this remedy. 

It has proved useful in chorea, in tie-douloureax (Beigel, Du Cazal), 
but other remedies are doubtless better. 

Authorities referred to : 

Beigel, Dr. H. Journal of Anatomy and Physiology, vol. ii., p. 329. 

Bernard, Cl. Lcfons sur les Effets des Substances Toxiqy.es el Medicamenteuscs. Paris, 
1857, p. 23S. 

Bock, C, u. Hoffmann, F. A. Quoted by Vulpian. 

Hammond and Mitchell. The American Jour, of the Med. Sciences, July, 1859. 
Experimental Researches regarding Carroval and Vao. 

Kolliker, A. Virehow's Archiv, Band x., p. 3. Physiologische Untersuchungen uber 
die Wirhung einiger Gifte. 

Riegel, Dr. Franz. Centralblatt f. d. med. Wiss., 1871, p. 401. Ueber den Einfluss 
des Curare auf die Korperlernperatur. 

Tarchanoff, M. J. Archives de Physiol. Norm, ct Path., January and February, 1875. 
De V Influence du Curare sur la Formation de la Lymphe ct V Emigration des Globules 
blancs du Sang. 

Voisin et Liouville. Gaz. Hcbdom., Nos. 32-37, 1866. 

Vulpian, A. Lecons sur V Action Physiol, des Substances Toxiques et Medicamenteuscs, 
Paris, 1881, pp. 193-422. 

Watson, Dr. Amer. Jour, of the Med. Sciences, July, 1876. 

Zeleuski, Dr. Virehow's Archiv, Band xxiv., p. 362. Zur Frage von der Muskcl- 
irritabilitdt. 

Gelsemium. — Yellow jasmine. "The root of gelsemium semper- 
virens." 

Mctractum Gelsemii Fluidum. — Fluid extract of gelsemium. Dose, 
m. ij. — m. x. 

Preparations. — The fluid extract is the only official preparation ; 
but this is effective, certain, and easily managed. A tincture is pre- 
pared by macerating four ounces of the fresh root in two pints of 
diluted alcohol. The dose of this tincture is from ten to thirty drops. 
The so-called gelseminine is obtained by evaporation of the tincture, 
and is a very uncertain preparation ; the dose is gr. ss — gr. ij. It is 
only used by the eclectic practitioners. 

Disappointment is frequently experienced from the use of gelsemium 
preparations, owing to the fact that they are made from the dried root. 
In the process of drying, even spontaneously, the alkaloid disappears. 



GELSEMIUM. 463 

The most trustworthy preparation is the officinal fluid extract, prepared 
conscientiously from the fresh root. 

Composition. — Gelscmium contains a very powerful alkaloid — gelse- 
mia or gehemina — and gelsemic orgt&Si minic acid, identical with ceecu- 
lin. It contains also an acrid resin, volatile oil, gallic acid, a yellow 
coloring-matter, besides some other unimportant ingredients. 

Gelsemia. — " In its pure state gelseminine (gelsemia) is a colorless, 
odorless solid, having an intensely persistent, bitter taste. It has 
strongly basic properties, completely neutralizing the most powerful 
acids, forming salts of which the sulphate, nitrate, chloride, and acetate 
are freely soluble in water." Dose, gr. -gL — gr. -fa. 

Antagonists and Incompatibles. — The caustic alkalies and tannic 
acid are chemically incompatible. As respects the physiological actions 
gelsemium is antagonized by the diffusible stimulants, by alcohol, am- 
monia, opium, digitalis, etc. The lethal effects are best treated by 
emetics, warmth, alcoholic stimulants, by faradization and artificial 
respiration, and by morphia subcutaneously. 

Synergists. — Conium, physostigma, tobacco, opium, etc., when ad- 
ministered with gelsemium, increase its effects in the whole sphere of 
its physiological activity. 

Physiological Actions. — The preparations of gelsemium have a 
bitter and somewhat aromatic taste, and a narcotic odor. They do not 
produce gastric irritation. The active substance, being crystalloidal, 
diffuses into the blood with facility. In moderate doses, but sufficient 
to produce decided physiological effects, gelsemium causes a feeling of 
languor and mental calm, slowing of the action of the heart, drooping 
of the eyelids, dilatation of the pupil, and some feebleness of muscu- 
lar movements. In larger doses the physiological effects are as fol- 
lows : vertigo, double vision, ambhyopia, paralysis of the levator pal- 
pebral so that the upper eyelid cannot be raised, dilated pupil, la- 
bored respiration in consequence of a paretic state of the respiratory 
muscles, slow and feeble action of the heart, great muscular weakness, 
and sensibility to pain and touch much reduced. These effects are pro- 
duced in about a half-hour after the stomach administration, and last 
two or three hours, when they subside. "SVhen lethal doses are taken, 
the above-described symptoms occur in a more intense degree. The gait 
is at first staggering, but the power of muscular movement soon ceases, 
and a sense of numbness diffuses over the body. The eyelids close 
(paralysis of the levator), the pupils dilate widely, vision is lost, and 
the pupils cease to respond to the stimulus of light. The lower jaw 
drops, and the power of .speech is lost in consequence of paralysis of 
the muscles of the tongue. The respirations are labored, shallow, and 
irregular ; the action of the heart weak, feeble, and intermittent. Gen- 
erally the skin is covered with a profuse perspiration, but no other 
evacuation takes place. Death occurs from asphyxia, and the action 



464 MOTOR DEPRESSANTS. 

of the heart ceases after the respiratory movements. Consciousness is 
preserved until near the close, and until carbonic poisoning ensues. In 
one instance (Wormley) extreme restlessness was noted, but generally 
there is a condition of calm, a soporose state, or the unconsciousness of 
carbonic-acid narcosis, and convulsions never occur. 

The author's investigations have demonstrated that gelsemium is a 
paralyzer of motility and sensibility ; that sensibility is first affected in 
cold-blooded animals (frogs), and afterward motility, and that in warm- 
blooded animals the motility is affected before sensibility. As respects 
the seat of the action, the author has ascertained that the end-organs 
of the motor nerves, and the nerve-trunks, do not lose their irritability, 
and that the muscular contractility is unimpaired. "Its paralyzing 
effect is due to its action on the motor centre, and not to an action on 
the peripheral nerve-fibres. It acts also on the sensory portion of the 
cord, producing at last complete anaesthesia ; but this effect in warm- 
blooded animals, and in man, is toxic only, and follows the paralysis of 
the motor functions." Applying the precise observations which are 
made on animals to the explanation of the lethal effects which hare 
occurred in man, we are conducted to the following conclusions : the 
disorders of voluntary movement, and the more or less complete pa- 
ralysis of the motor and of the sensory functions, are due to the effects 
of gelsemium on the motor and sensory portions of the cord, the func- 
tions of the sensory columns resisting longer the action of the poison. 
The labored respiration is due to the paretic state of the respiratory 
muscles, especially of the diaphragm. The depressed action of the 
heart is probably secondary to the diminished respiration movements, 
which produce this result by impeding the flow of blood through the 
pulmonary capillaries. The dilated pupil, the double vision, the ptosis, 
are due to paralysis of the third pair. 

In rabbits and cats gelsemium, in lethal doses, affects motility in a 
very remarkable manner: when the paralyzing effects are becoming 
manifest — first in the fore extremities — these animals perform a series 
of backward movements, in which sometimes a complete backward 
somersault occurs. In pigeons, general muscular tremors precede the 
backward movements. No corresponding acts have taken place in the 
fatal cases observed in man. A very considerable reduction of tem- 
perature occurs from lethal doses in warm-blooded animals. 

The author's experimental observations on the physiological actions 
of gelsemium have since been fully confirmed by Ott and by Ringer, in 
an elaborate series of investigations. The study of Ringer and Mur- 
rell is a model of a research of this kind. 

Therapy. — Gelsemium is indicated in those maladies in which an 
exaltation of function has taken place in the motor and sensory spheres 
of the nervous system. Several cases of tetanus have been reported 
cured by this remedy ; but it is impossible to say whether these were 



GELSEMIUM. 465 

examples of post hoc or propter hoc. A priori it might be expected 
that gelsemium would prove serviceable in this disease, because its ac- 
tion on the spinal cord is opposed to that which takes place in tetanus. 
In strychnia-poisoning in animals, however, the tetanic spasms are not 
prevented by the administration of gelsemium. In mania, with great 
motor excitement and wakefulness, this remedy is more useful than 
conium. To produce the best results from its administration, doses of 
sufficient strength must bo given to produce definite physiological ef- 
fects, viz., dilated pupil, drooping of the eyelids, and a feeling of lan- 
guor. In the condition of " horrors " from alcoholic excess, in simple 
icakefulness, in the insomnia which results from over-excitement and 
too great physical activity, cures are not unfrequently obtained by the 
use of gelsemium. In the inflammatory affections of the meninges, 
and in cerebro- spinal meningitis, sporadic or epidemic, with a decided 
febrile reaction, this agent is extremely useful in small doses (m. v of 
fluid extract), repeated every two hours so as to maintain a uniform 
physiological effect. 

Gelsemium has been used with success recently in the treatment of 
neuralgia of the fifth nerve. Cases cured by this remedy were, doubt- 
less, not instances of the tic-douloureux, but nerve-pain caused by cold, 
rheumatism, or temporary excentric irritation. Intercostal neuralgia, 
and especially myalgia, is frequently cured by this agent ; but con- 
siderable doses are necessary — from five to twenty minims of the fluid 
extract every three hours until the characteristic drooping of the eye- 
lids, dilatation of the pupil, and muscular languor, manifest themselves. 

In convulsive, or spasmodic cough, gelsemium often affords remark- 
able relief. It is beneficial in the spasmodic stage of whooping-cough, 
reflex cough from irritation of the laryngeal nerves, the irritative 
cough of phthisis with scatity expectoration, and the nervous cough of 
hysterical subjects. In some cases of spasmodic asthma great relief 
is afforded by gelsemium, but, as is the case with all other remedies for 
asthma, it frequently fails and loses its good influence even in those 
cases in which, it was at first successful. 

The author has witnessed excellent results from the use of gelse- 
mium in acute inflammations of the lungs and pleura. In pneumonia 
it affords rest by diminishing the activity of the respiratory function ; 
it allays cough, and, by depressing the cardiac movements, it lessens 
stasis of the pulmonary capillaries and lowers the temperature. It is 
better to give medium doses (m. v — m. x of the fluid extract), every 
two hours, to maintain a constant effect within the limits of safety. It 
favors, when exhibited in this way, the occurrence of an early crisis, and 
assists in the production of one critical evacuation — the sweat. A simi- 
lar mode of administration should be pursued in pleuritis, in which its 
use is equally rational and effective. 

Very great relief is afforded by the use of gelsemium in certain pel- 
31 



466 MOTOR DEPRESSANTS. 

vie disorders in women. There is no more generally-useful medicine in 
ovarian neuralgia. The pains of dysmenorrhcea are also greatly alle- 
viated by it. The evidence is conclusive that this remedy also suspends 
after-pains, and it is held by some good observers that it quiets the 
"nagging" pains of the first stage of labor. In these disorders of the 
female sexual organs, it is generally necessary to administer a quantity 
of the remedy sufficient to produce some of its characteristic physio- 
logical effects. 

The first empirical use of gelsemium was in the treatment of the 
remittent, or so-called bilious fevers of the South. A considerable num- 
ber of facts have been accumulated, which show that this remedy exer- 
cises a really beneficial influence in remittent and typo-malarial fevers. 
It is not an action of specificity — like quinia in intermittent and remit- 
tent fevers. Its power to depress the temperature is probably the real 
explanation of its utility. 

Authorities referred to : 

Bartholow, Dr. Roberts. . Experimental Investigations into the Actions and Uses of 
Gelsemium Sempervirens. The Practitioner, London, vol. v., p. 200. 

Ott, Dr. Isaac. On Gelsemia, pamphlet, 1865. Also, Philadelphia Medical Times, 
vol. V. 

Porcher, Dr. Fraxcis Peyre. Resources of the Southern Fields and Forests, p. 501. 

United States Dispensatory, thirteenth edition. 

Wormley, Dr. Theodore. A Contribution to our Knowledge of the Chemical Compo- 
sition of Gelsemium Sempervirens. American Journal of Pharmacy, vol. xlii., January, 
\S10. 

Arnica. — Arnica. " The flowers of arnica montana." Racine d'ar- 
nica, Fr. ; Arnicawurzel, Ger. 

Tinctura Arnicas. — Tincture of arnica. Dose, m. x — 3 ss. 

Composition. — The chemistry of arnica has not as yet been thor- 
oughly elucidated. Walz has isolated a principle (arnicme). The 
root contains an essential oil on which depends, in great part, its physi- 
ological activity. The oil is a complex substance. One of its most im- 
portant constituents is trimethylamine. 

Antagonists and Incompatibles. — The actions of arnica are an- 
tagonized by ammonia, alcoholic stimulants, opium, camphor, etc. 

Synergists. — Aconite, veratrum viride, digitalis, and arterial seda- 
tives generally, increase the effects of arnica. 

Physiological Actions. — Arnica excites considerable irritation of 
the skin, if the contact be sufficiently prolonged. It produces when 
swallowed a sense of heat and acridity in the fauces, and increases the 
flow of saliva. It is decidedly irritant to the stomach, and causes in 
large doses nausea and vomiting, and choleraic diarrhoea. Its active 
principles diffuse into the blood. In small medicinal doses arnica in- 
creases the action of the heart and arteries, and excites the functions 



TKIMETIIYLAMIXE. 467 

of the skin and kidneys. In large doses, probably after a short stage 
of excitement, depression of the circulation, of the respiration, and of 
the animal temperature, ensues ; violent headache is experienced, the 
pupils are dilated, and paresis of the muscular system comes on. In 
toxic doses arnica paralyzes the nervous system of animal and organic 
life, and death ensues in a condition of collapse. 

Therapy. — In febrile diseases and inflammations, when there is 
sthenic reaction, arnica in full doses depresses the action of the heart 
and lowers the arterial tension. It is, therefore, antipyretic. For the 
production of this effect, an infusion is probably a better preparation 
than the tincture. When, however, in febrile diseases there is present 
the condition of asthenia, small doses of the tincture (five minims) are 
to be preferred. That this remedy will produce different results, in 
small or large doses, need not occasion surprise. It is conceded on all 
sides that the effects of opium differ according to the size of the dose, 
and the frequency with which it is repeated. 

Good results have been obtained from the use of arnica infusion in 
mania and melancholia. The tincture of arnica is exceptionally ser- 
viceable in delirium tremens, with depression. 

In rheumatism and rheumatic gout, very decided curative effects 
have been obtained from arnica. The fact that it contains trimethyla- 
mine is probably the true explanation of its utility in these affec- 
tions. 

The tincture of arnica has a popular reputation for the relief of 
sprains, biiiises, and external inflammations. The author has known 
violent erysipelatous inflammation to follow its application to a sprained 
ankle. It is extremely doubtful whether the good effects are more de- 
cided than those of a spirit-lotion. The infusion or decoction does not, 
it is said, cause local irritation. 

Authorities referred to : 

Husemaxx, Dr. Theodor. Handbuch der gesammten Arzncimiitellehre, zweiter Band, 
?. 978. 

Phillips, Dr. C. D. F. Materia Medico, and Therapeutics, p. 305. 
Stille, Dr. A. Therapeutics and Materia Midica,xd\. i., p. 791. 

Trimethylamine. — (Unofficial.) This is an ammoniacal substance, 
having a strong, fishy odor. It is isomeric with propylamine, which is 
also an ammonia. As the propylamine of commerce is a mixture of 
various substances, and is of uncertain composition, trimethylamine only 
should be used (Spencer). The dose of trimethylamine is four to eight 
minims. Its disagreeable taste may be disguised somewhat by pepper- 
mint-water. 

Properties. — Trimethylamine is a colorless liquid, having the com- 
position C 3 H 9 N. It dissolves freely in ether, alcohol, and water, has a 
strong alkaline reaction, and is inflammable. 



468 MOTOR DEPRESSANTS. 

Chloride of Trimethylamine is a stable salt which crystallizes in 
long needles; it is very deliquescent, and its solution when concen- 
trated has a caustic action on the skin and mucous membrane. It is 
free from odor, except when heated or mixed with an alkali, when the 
fishy smell is evolved. The taste of a solution of this salt is alkaline, 
but not disagreeable (Dujardin-Beaumetz). Dose, grs. ij every three 
hours. 

Antagonists and Incompatibles. — Chemically trimethylamine is 
incompatible with the mineral acids, the salts of the metals, the alkalies 
(chlorides), and vegetable infusions. It should always be prescribed 
alone, in solution, in some aromatic water. Therapeutically it is an- 
tagonized by the stimulants, opium, belladonna, digitalis, etc. 

Synergists. — All agents depressing the vascular system and the 
temperature are synergistic. 

Physiological Actions. — Applied to the skin, mucous membrane, 
or areolar tissue, trimethylamine produces decided caustic effects, com- 
parable to those which result from the action of ammonia. It excites 
gastric pain when taken into the stomach in considerable doses, and 
will, doubtless, cause a high degree of inflammation if incautiously ad- 
ministered. The most characteristic effects are the lowering of the action 
of the heart, the depression of the temperature, and the diminution in the 
amount of urea excreted. In the physiological state Dujardin-Beaumetz 
found, in some experiments on himself, that the chloride of trimethyla- 
mine lessened the temperature and the pulse, but these results were 
much more decided when it was administered in cases of acute rheuma- 
tism. The influence which this agent has on the excretion of urea is 
still more remarkable. The observations of Dujardin-Beaumetz show that 
a gradual but considerable decline in the excretion of urea is a con- 
stant result of its administration. On the other hand, Spencer says that 
the excretion of urea is sometimes increased, and, in one case in which 
the urinary discharge was carefully studied, the urine was almost trebled, 
and the urea more than doubled, by the use of this remedy. If the 
diminution of the amount of urea were a constant result, as claimed by 
Dujardin-Beaumetz, the influence which trimethylamine has on the 
body temperature might be due to an interference with the combustion 
process. But the facts do not as yet justify the construction of a theory 
as to its mode of action. 

Therapy. — Thus far almost the only application made of trimethyl- 
amine is in the treatment of acute rheumatism and gout. In some 
cases it appears to produce almost complete relief after the administra- 
tion of a few doses, but generally a longer time is required (Awenarius, 
Dujardin-Beaumetz, Spencer, Leo). It moderates, at once, the fever 
and the joint-pain, and very decidedly shortens the duration of the dis- 
ease. It is said to diminish the tendency to cardiac complication. 

This agent, having so decided an influence on the pulse, temperature, 



PILOCARPUS. 4G9 

and excretion of urea, will, in the future, doubtless be applied to the 
treatment of other maladies. 

Authorities referred to : 

Buchheim, Dk. Eiuvin. Uebcrdas Trimethylamin. Schmidt's Jahrbuchcr, vol. lxxxiii., 
p. 13. 

Dujardin-Beattmetz, Dr. Du Chlorhydratc dc Trimethylamine dans le Traitement du 
Rhumatisme Articulaire Aigu. Bulletin General de Therapeutique, vol. lxxxiv., pp. 337, 
395. 

Leo, Dr. Berliner klinische Wochcnschrift, 1875. 

Petit, M. A. Sur la Trimethylamine. Bulletin General de Therapeutique, vol. lxxxiv., 
p. 313, ct scq. 

Spencer, Dr. W. H. On the Employment of Trimethylamine in Rheumatism and 
Gout. The Practitioner, February and March, 1875. 

Pilocarpus. — Jaborandi. A plant belonging to the family of 
rutaceae — pilocarpus pinnatus (Gubler). 

Infusum Pilocarpi. — Infusion of jaborandi ( 3 ij — Oj). Dose, 3 ss 

— I ij- 

Extractum Pilocarpi Fluidxcm. — Fluid extract of jaborandi. Dose, 

3 ss — 3 ij. 

Tinctura Pilocarpi. — Tincture of jaborandi ( 3 iv — Oj). Dose, 
3 ss — 3 ij. 

Pilocarpine Nitrate. — Dose, gr. \ — \. Also, sulphate and muriate. 

Composition. — The important constituent is the alkaloid — pilocar- 
pine — which possesses the physiological properties of the drug. It 
combines with acids to form salts. The salts of pilocarpine crystallize 
in the oblique system, and are soluble in water. Probably the most 
eligible preparation is the nitrate. It may be administered hypoder- 
mically. 

Antagonists and Incompatibles. — The caustic alkalies, the per- 
salts of iron, and the salts of the metals generally, are chemically 
incompatible. A remarkable antagonism has been shown to exist 
between jaborandi and belladonna (Ringer and Gould). 

Synergists. — Aconite, veratrum viride, gelsemium, and remedies 
which paralyze the vaso-motor nervous system, promote the activity of 
jaborandi. 

Physiological Actions. — The taste of jaborandi is rather hot and 
pungent. The considerable doses of the crude drug required to pro- 
duce physiological effects excite nausea and vomiting, especially if 
taken on an empty stomach. It has been shown, however, in recent 
experiments, that these results follow the use of the alkaloid ; hence it 
may be concluded that not bulk alone is the cause of the gastric dis- 
tress, but that it is one of the physiological properties of the drug. 

The active principles of jaborandi diffuse readily into the blood. In 
about ten minutes after the infusion is swallowed, the face, ears, and 
neck, become deeply flushed. Simultaneously perspiration begins on 



470 MOTOR DEPRESSANTS. 

the skin, an abundant flow of saliva takes place, the nasal and bronchial 
mucus, and the tears, are increased, and watery diarrhoea may occur. 
It is said that, when the salivary secretion is greatly increased, that of 
the skin is relatively less so, and vice versa (Fereol), but this is not 
generally admitted. The quantity of perspiration poured out by the 
skin is enormous — the sweat runs from the body and soaks the clothes. 
The quantity of saliva discharged is also very great. Ringer reports 
that in two of his cases the amount of saliva was respectively twenty 
two ounces and twenty-seven ounces. 

The action of the heart is increased b}' jaborandi, but the arterial 
tension is notably diminished. The rise in the pulse-rate averages 20 
beats, and the duration of this effect is about two and a half hours. A 
very distinct fall of temperature (0.5° to 2° Fahr.) ensues when the 
sweating begins, and this decline of body-heat is maintained on an aver- 
age about four and a half hours. According to Robin, a transient rise 
of temperature precedes the fall, but Ringer and Riegel deny the accu 
racy of this observation. 

The effects of jaborandi on children, according to Ringer, are, singu- 
larly enough, much less, for corresponding doses, than on adults, as 
respects the flushing, the sweating, the salivation, and the temperature. 

More or less drowsiness, both in children and adults, follows the 
profuse sweating, and pallor succeeds to the flushing. Chilliness is ex- 
perienced with the cessation of the sweating stage. Languor and de- 
bility persist for some hours after the completion of the effects. The 
drowsiness is probably not due to a direct action of the remedy on the 
cerebrum, but to the greatly-diminished vascular tonus, and to the loss 
of fluid from the vessels. Vision is generally affected. The pupil is 
usually contracted, and the power of accommodation is impaired. No 
characteristic or constant changes in the fundus of the eye have been 
observed on ophthalmoscopic examination. Locally applied to the eye 
jaborandi causes " contraction of the pupil, tension of the accommo- 
dative apparatus of the eye, with approximation to the nearest and 
farthest points of vision, and amblyopic impairment of vision from 
diminished sensibility of the retina." The eye resumes its normal state 
in about an hour and a half (Tweedy). 

The results of experiment indicate that the action of jaborandi is 
paralyzant of the vaso-motor nervous system. The flushing of the skin 
is doubtless due "to dilatation of the arterioles, and the increased action 
of the heart must be referred to the same cause. The sphygmograph 
demonstrates the lowering of the vascular tension. The decline in tem- 
perature must be referred chiefly to the profuse transpiration, but the 
depression of the vascular tonus may also somewhat influence this re- 
sult. The data do not yet exist for a statement of the mode in which 
jaborandi excites the salivary and cutaneous secretions. It probably 
affects the end-organs of the excito-secretory nerves. 



PILOCARPUS. 471 

Elimination of the active constituents of jaborandi probably takes 
place through the organs whose functions are so powerfully excited. 
It is a remarkable circumstance that the amount of urea passing out in 
the sweat caused by jaborandi is enormously increased over the normal, 
amounting to from fifteen to seventeen grains. The urine is not in- 
creased. Hence it may be concluded that elimination does not take 
place by the kidneys. 

The experiments which have demonstrated the existence of a physi- 
ological antagonism between jaborandi and belladonna have thrown 
much light on the action of the former. When the heart of a frog is 
arrested in the diastole by jaborandi, it immediately recommences its 
beat when atropia is subcutaneously injected (Langley). When the 
superior ganglion of the cervical sympathetic, and the lingual, and the 
pneumogastric nerve are divided, jaborandi administered causes profuse 
salivary secretion ; but this action is at once antagonized, and the secre- 
tion arrested by the injection of atropia. These agents, therefore, are 
exactly opposed as respects their action on the nerve-endings in the 
salivary glands (Carville). The effects of one grain of atropia, in a boy 
poisoned by it, were, as respects the state of the mouth and skin, an- 
tagonized by thirty grains of jaborandi. In three men the perspiration 
and sativation, caused by sixty grains of jaborandi, were arrested by 
the subcutaneous injection of y^j- of a grain of atropia (Ringer and 
Gould). 

Therapy. — Pilocarpus, acting as it does on the salivary glands, has 
been used with varying success in mianjys. It is contra-indicated in all 
affections of the gastro-intestinal mucous membrane, and in weak heart 
due to disease of its muscular substance, or of its contained ganglia, or of 
the valves. It is a remedy of great value in cardiac drojisy, provided the 
contra-indications above mentioned do not exist ; its therapeutic power 
being much the same as the vapor, hot air bath, and other means for 
promoting free diaphoresis. The effusions of pleuritis, hydrothorax, and 
ascites, have been quickly removed by this agent. In asthma with pro- 
fuse expectoration (humid asthma), and in bronchitis with abundant, 
non-purulent exudation, it has often been very beneficial. It must be 
used with caution, or not at all, in the difficult breathing due to dilata- 
tion of the right cavities and great venous trunks. In renal drojisy, 
especially scarlatinal, there being no contra-indication in the state of the 
heart, it is a remedy of the greatest utility. The same fact is true of 
uraemia, and puerperal eclampsia of renal origin. It has decided abor- 
tifacient powers, several cases having occurred recently from the hypo- 
dermatic injection of the alkaloid. Pilocarpine (hypodermatically) has 
proved to be of great utility in various diseases of the eye, with effusion 
and exudation, and in paralysis of the third nerve (Wecker). 

Ringer has used jaborandi with success to increase the secretion of 
milk. As the milk-glands correspond in structure to the sudoriparous 



472 MOTOR DEPRESSANTS. 

glands, and are merely differentiated and specialized for their particu- 
lar office, the effects of this drug in increasing the production of milk 
might have heen, a priori, expected. The author has used recently a 
fluid extract of jaborandi successfully in a case of deficiency in the 
secretion of the milk of a nursing-woman. 

In two cases of that very intractable disorder diabetes insipidus, or 
polydipsia, Laycock has used jaborandi with the effect to reduce the 
quantity of urine in one case from three hundred ounces to one hun- 
dred and twenty ounces per diem, and, in the other, from one hundred 
and fifty-eight ounces to ninety-eight ounces per diem. 

In scaly slcin eruptions, pilocarpus has good effects by maintaining 
a moist state of the skin. It is the most efficient remedy for alopecia 
which we possess. In the treatment of this affection pilocarpine may 
be injected subcutaneously, or the fluid extract can be applied locally. 
The following is a very successful topical application : rj. Ext. pilo- 
carpi fl. | j ; tinct. cantharidis, 3" ss ; lin. saponis, 3 ijss. M. S. The 
scalp must be well rubbed with this lotion daily. In prurigo Pick 
had success, but failed in psoriasis, and he also succeeded in two 
cases of pruritus senilis and in one of urticaria. In alopecia pity- 
rodes, he had good results in ten cases, but not in alopecia areata. 
Pick administered one-sixth of a grain three times a day by the 
stomach. 

Recently Guttmann has brought forward pilocarpine as a remedy 
for diphtheria. His strong claim for its utility is supported by Lax, 
and Lashkewitz has as decidedly opposed it, all of his severe cases 
treated with it having died. 

Physostigma. — Calabar bean. The seed of physostigma venenosum. 
Fkve de Calabar, Fr. ; Kalabarbohne, Ger. 

Extracturn Physostigma;. — Extract of Calabar bean. Dose, gr. \ — 
gr. ss — gr. v. 

Tinctura Physostigmce. — Tincture of physostigma. Dose, m. v — 
m. xx. 

Composition. — Calabar bean contains two alkaloids, p>hysostigmine 
and eserine. These have been supposed to be the same, but they 
differ in important particulars. Physostigmine has an alkaline reac- 
tion, is amorphous, colorless, and tasteless. Eserine crystallizes in 
colorless, rhomboidal plates, and has a bitter taste. Eserine has strong 
basic properties, and combines with acids to form salts, which are 
freely soluble. The Calabar bean contains, besides these alkaloids, the 
ordinary constituents of the common bean, viz., albuminous matters, 
starch, and oil. 

Antagonists and Incompatibles. — The vegetable astringents, tan- 
nic acid, and the caustic alkalies, are chemically incompatible. As 
respects physiological actions, physostigma is antagonized in a limited 



PHYSOSTIGMA. 473 

part, but not in the whole of its actions, by atropia, and still more by 
chloral. Therapeutically, the tetanizing agents may be regarded as 
opposed to physostigma. 

Synergists. — The paralyzers, or depressors of the motor nervous 
system, conium, gclseniium, nitrate of amy], etc., act in harmony with 
physostigma, increasing its effects in the whole range of its physio- 
logical influence. 

Physiological Actions. — The preparations of physostigma are apt 
to excite nausea. Increased secretion of the gastro-intestinal mucous 
membrane, and increased peristalsis, follow their administration. The 
active principles quickly diffuse into the blood. Physostigma does not 
impair the respiratory function of the blood, but, after death, loose 
coagula are found, the globules have undergone changes of shape, and 
rectangular plates of haemato-crystalline occur (Leven and Laborde). 
The action of the heart is affected by considerable toxic doses ; it is 
paralyzed in the diastole, and is flabby, but it contracts lazily on elec- 
tric stimulation. In less than lethal doses the action of the heart is 
slowed, and the arterial tension is, for a brief period, lowered, but soon 
rises considerably above the normal. As these effects are not due to 
an action on the inhibitory apparatus, and follow when the heart is 
separated from the vaso-motor centre by division of the spinal cord, it 
is probable that the action consists in a stimulation of the cardiac gan- 
glia, and a subsequent paralyzing action on the cardiac muscles. The 
same result may be due to a paralyzing action on the accelerator nerves 
of the heart (Kohler). The respiration is more powerfully affected than 
the circulation. When a lethal dose is administered the respiration 
becomes slower and shallower, and death ensues from arrest of the re- 
spiratory movements (asphyxia), the heart continuing in action for 
some time afterward. 

Physostigma does not affect the centres of conscious impressions, 
and consciousness is preserved until the oxygenation of the blood is so 
far interfered with that carbonic-acid narcosis supervenes. Giddiness, 
vertigo, and a sense of muscular weakness and fatigue, are produced 
by considerable doses (Gubler). When a lethal dose is administered to 
an animal, its muscular system soon grows weak, and complete paraly- 
sis soon after ensues. The voluntary muscular system, however, be- 
fore complete resolution occurs, is agitated by a succession of tremors 
— temporary tetanic contractions followed by entire relaxation. These 
muscular tremblings occur, but more feebly after complete paralysis, 
and persist in a slight degree after death. The muscular contractility 
is not destroyed, not even impaired by physostigma. 

The irritability of the motor nerves is affected, if at all, to a very 
slight extent, and the sensibility of the sensor}' nerves is rather height- 
ened. It follows from these facts that the paralyzing effect of physos« 
tigma is due to a direct action on the spinal cord. 



474 MOTOR DEPRESSANTS. 

Attention has not thus far been directed to the influence of physo- 
stigma on the pupil. Whether introduced directly into the eye, or taken 
into the stomach, or thrown under the skin, it contracts the pupil. This 
is a local and peripheral action, exactly corresponding, as to its seat, to 
the action of atropia. The end-organs of the sympathetic, or of the 
motor oculi, and it may be of both, are acted upon. By some it is held 
that the contraction of the pupil is due to a tetanic state of the circular 
fibres (Grlinhagen, Rogow) ; by others, to a paralysis of the dilator 
system (Fraser, Hirschmann). It were probably safer to accept the 
conclusion that the nerves innervating both sets of fibres are acted on — 
the motor oculi stimulated (see case by T. Wharton Jones, Practitioner, 
vol. iii.), the sympathetic depressed — for we find that tetanic contraction 
of the muscular fibre of the intestine, followed by dilatation and a paret- 
ic state, can be experimentally produced by physostigma. The appara- 
tus of accommodation is also affected; myosis begins in ten to fifteen 
minutes after the disks are inserted. Direct galvanization of the iris, 
contracted by physostigma, causes it to dilate (Engelhardt, Hermann). 

Therapy. — The applications of physostigma to the treatment of dis- 
ease are by no means so important as the elaborate study given to its 
physiological action, by various observers, would seem to indicate. 

In torpor of the muscular layer of the intestine, combined with 
deficient secretion of the mucous membrane, this agent is often very 
serviceable. In some subjects fifteen minims of the tincture, or a half- 
grain of the extract, taken at bedtime, will procure a morning evacua- 
tion, but it frequently fails. When the state to be relieved is such as 
is indicated above, a combination of physostigma, belladonna and nux- 
vomica is sometimes very effective : R. Tinct. physostigmse, tinct. 
nucis vomicae, tinct. belladonna;, aa 3 ij. M. Sig. Thirty drops in 
water morning and evening. R. Extract, physostigma?, ext. bella- 
donna?, ext. nucis vomicae, aa gr. v. M. ft. pil. no. x. Sig. One pill 
at bed-hour. Physostigma (gr. \ — gr. ss of the extract) is a useful ad- 
dition to a cathartic pill. R. Ext. physostigma;, resinse podophylli, 
aa grs. iij. M. ft. pil. no. vj. Sig. One pill at bed-hour. 

To the troublesome flatulence of women at the climacteric period^ 
usually associated with a paretic state of the muscular layer of the 
bowel, very great relief is often afforded by the use of physostigma. 
With the relief to the flatulence there usually follows relief to the mor- 
bid fancies, the headache and vertigo connected with it. 

The action of physostigma on the spinal cord, as a paraiyzer, natu- 
rally suggested its use in tetanus. The evidence of its utility is dis- 
crepant. Moreover, tetanus, in many instances, manifests a tendency to 
spontaneous cure. It is difficult, therefore, to estimate the precise value 
of physostigma, but about one-half of the cases treated with this agent 
recover — according to Watson ten in eighteen, according to Roemer 
twenty in forty-seven cases. A larger measure of success might have 



PHYSOSTIGMA. 475 

been achieved, liad sufficient attention been paid to the quality of the 
extract used and to the mode of administration. The following re- 
marks by Dr. Fraser, in regard to the treatment of tetanus by Calabar 
bean, are of great importance : 

" I should myself feel inclined always to commence the treatment 
by subcutaneous injection, and to repeat such injection until the system 
is decidedly affected, and then to administer the remedy by the mouth 
in a dose three times as large as is found necessary by subcutaneous in- 
jection. Such a plan might be quite safely followed in a child of even 
nine years. If the remedial effects continue to be produced by admin- 
istration by the mouth, it should be persevered with, for such admin- 
istration 'has obvious advantages as far as the convenience of the prac- 
titioner is concerned. In the more severe cases, however, I believe 
subcutaneous injection should be alone employed. The distress and 
increase of spasm caused by swallowing, or the impossibility of intro- 
ducing substances by the mouth, will render this necessary. I cannot, 
also, too strongly urge that subcutaneous injection should always be 
jsed when severe. and continued spasms occur, when a fatal result is 
imminent from the exhaustion caused by prolonged and frequent con- 
vulsions, and when apncea threatens at once to close the tragic scene. 
By it we obtain the quickest and most powerful effect. 

" From the preceding remarks it cannot be expected that any arbi- 
trary rules of dosage can be laid down. For an adult one grain of the 
extract by the stomach, or one-third of a grain by subcutaneous injec- 
tion, will generally be sufficient to commence with. This should be 
repeated in two hours, when its effects will usually have passed off, and 
the succeeding doses may be modified according to the experience that 
will be thus, gained. . . . The great object is to produce as quickly as 
possible, and then to maintain, the physiological effect of physostigma 
in diminishing reflex excitability. The doses must, therefore, be con- 
tinued in increasing quantities until this physiological effect is pro- 
duced, or until the sedative action of the drug on the circulation is 
carried to a dangerous extreme, or until constant nausea and vomiting 
• compel us to desist." 

Influenced by theoretical considerations, physostigma has been pre- 
scribed in chorea and epilepsy, but the results have not been encour- 
aging. It is true successful cases of chorea have been reported, but the 
influence of favorable hygienic surroundings and time is so great in 
uncomplicated chorea, that we may well doubt whether physostigma 
has any real influence. Of twelve cases of epilepsy treated by this 
agent six were improved, and in the other six a notable increase in the 
number of the epileptic paroxysms took place (Williams). 

In progressive paralysis of the insane remarkable improvement has 
occurred under the use of physostigma in a few cases (Browne), but in 
others the results have been entirely negative (Williams). As in this 



476 • MOTOR DEPRESSANTS. 

melancholy disorder no remedies have hitherto been 6f any avail, it is 
a gratifying fact that in some cases Calabar bean has seemed to stay 
its progress. 

Since it has been shown that physostigma lessens the activity of 
the respiratory function, lowers the action of the heart, and depresses 
the temperature, it has been used in bronchitis, congestion of the lungs, 
and pneumonia, with a degree of success which warrants more extended 
and systematic use. 

Besides the various applications in ophthalmic practice growing out 
of the myosis produced by physostigma, it has been used with success 
in certain paralytic and convulsive states of the ocular muscles. In 
a case of paralysis of the third nerve, with ptosis, double vision, and 
immobile pupil, Wharton Jones effected a cure by the instillation of 
physostigma into the eye, whence he concludes that the myosis caused 
by this agent is due to the stimulation of the third nerve. Galezowski 
recommends the instillation of physostigma into the eye in cases of 
suppuration of the cornea, and in amblyopia. Eserine disks (of gela- 
tine) have been successfully employed in tic. 

The experiments — thirty in number — of the British Medical Associa- 
tion Committee, with regard to the antagonism between physostigma 
and strychnia, have led them to the following conclusion : 

" Although the symptoms produced by either substance were modi- 
fied considerably by the action of the other, there was no instance of 
recovery from a fatal dose." 

The antagonism between atropia and physostigma, at least to a con- 
siderable extent, has been well established, especially by the labors of 
Fraser. In 1864 KleinwSchter, influenced probably by the marked 
antagonism of the tvvo agents on the pupil, employed physostigma with 
success in a case of poisoning by atropia. The British Association Com- 
mittee, however, conclude as the result of their investigations that — 
" 1. Sulphate of atropia antagonizes to a slight extent the fatal action 
of extract of Calabar bean ; 2. The area of antagonism is more limited 
than even Dr. Fraser has indicated in his paper on the subject. 

Thirty-one experiments, performed by the committee with hydrate 
of chloral and Calabar bean, have shown that — 

" 1. Hydrate of chloral modifies to a great extent the action of a 
fatal dose of extract of Calabar bean, mitigating symptoms and pro- 
longing life. 

" 2. Hydrate of chloral, in some cases, saves life from a fatal dose 
of Calabar bean. 

" 3. If hydrate of chloral be given before extract of Calabar bean, 
so that the animal is deeply under the influence of hydrate of chloral 
before it receives the extract of Calabar bean, the symptoms produced 
by the latter are much modified, and life is saved from the effects of 
what would otherwise be a fatal dose. 



TOBACCO. 477 

" 4. Chloral hydrate is of little service as an antagonist to extract 
of Calabar bean, if given some time after the latter. If the symptoms 
of the action of Calabar bean be in full operation it will not save life, 
however it may modify symptoms." 

Uses of Eserine. — This alkaloid represents the powers of the 
plant, and is the most eligible form for internal administration, and for 
local use in ophthalmic therapeutics. The dose for internal and hypo- 
dermatic use ranges from -fo to -£ s of a grain. Gelatine disks of eser- 
ine are now most frequently employed for instillation into the eye, but 
a neutral solution of any of its salts is convenient for this purpose. It 
is now largely used to counteract the effects of atropia on the pupil ; 
in iritis to break away or prevent the formation of adhesions; in ulcera- 
tion and suppuration of the cornea; after extraction of cataract, to 
prevent suppuration (Wecker) ; in the operation of iridectomy. The 
curative influence of eserine in- these cases is due to its action in lower- 
ing the intra-ocular tension, in diminishing the conjunctival secretions 
by contracting the blood-vessels, and in checking the migration of the 
white blood corpuscles. (Wecker). Eserine may be substituted for 
physostigma for all purposes, by the stomach or hypodermaticalbj. 

Authorities referred to : 

Arnstein und Sctstchinskv. Schmidt's Jahrbucher der gesammten Medkin, Band 
cxlii., p. 2S6. 

Bennett, Dr. J. Hughes. Report of the Committee of the British Medical Association 
to investigate the Antagonism of Medicines. British Medical Journal, January 23, 1S73. 

Browne, Dr. J. Crichton. British Medical Journal, p. 60, January 10, 1874. 

Fraser, Dr. Thomas R. An Experimental Research on the Antagonism between the 
Actions of Physostigma and Atropia, Edinburgh, 1872. (I am indebted to the courtesy 
of Dr. Fraser for a copy of this important memoir.) 

Galezowski, Dr. Xavier. Gazette des Hopitaux, 124, 1869. 

Gruniiagen, Dr. Virchow's Archiv, Band xxx., p. 521. 

Hermann, Prof. Dr. L. Lehrbuch der experiment cllen Toxicologic, Berlin, 1874, p. 337. 

Jones, T. Wharton. The Practitioner, vol. iii., and vol. vii., p. 345. 

Koiiler, Dr. H. Experimentelle Beitrage zur Kenntniss der Herzwirkung des Calabar, 
etc. Archiv fur experimentelle Pathologie und Pharmacologic, 1873, p. 276. 

Laschejewich, Dr. Virchow's Archiv, vol. xxxv., p. 294. 

Laborde et Leven, MM. Gazette de Paris, 8, 6, 1870. 

Pam, Ci.ementi. (Gaz. Lomb.) Schmidt's Jahrbiicher, vol. cxlii., p. 286. 

Roemer, Dr. B. St. Louis Medical Journal, 1873, p. 367. 

Subbotin, Dr. Victor. Ext. sem. Physostigmatis vencn. bci atonischem Zustande des 
Darmkanals. Archiv fur klin. Mcdicin, vi., 2, 3, p. 285, 1869. 

Watson, Dr. Eben. Tlie Practitioner, vol. iii., p. 146, and Edinburgh Medical Jour- 
nal, May, 1867, p. 999. 

Tabacum.— Tobacco. Tabae, Fr. ; Tabakblcitter, Ger. " The com- 
mercial dried leaves of Nicotiana tabacum." 

Infusum Tabaci. — Infusion of tobacco ( 3 j — Oj). Dose, as an 
enema, § ss — § iv. 



478 MOTOR DEPRESSANTS. 

Oleum Tabaci. — Oil of tobacco. 

Unguentum Tabaci. — Tobacco-ointment ( 3 ss — § viij ). 

Vinum Tabaci. — Wine of tobacco ( 3 j — Oj ). Dose, m. v — 3 ss. 

Composition. — Tobacco contains a powerful alkaloid — Nicotia, or 
Nicotine — in combination with malic acid. It is an oily, colorless, 
liquid, strongly alkaline in reaction. Its taste is hot and acrid, and its 
odor disagreeable and peculiar. It is contained in the dried leaves, in 
the proportion of about five per cent. 

Tobacco also contains a peculiar camphor — Nicotianine. 

Tobacco-leaves are rich in mineral constituents — potash, lime, ni- 
trates, and phosphates. The vapor of tobacco " contains numerous 
basic substances of the picolinic series, and cedes to caustic potash, 
hydrocyanic acid, sulphuretted hydrogen, several volatile fatty acids, 
phenol, and creosote." (Fluckiger and Hanbury, Husemann.) It does 
not contain nicotia. The oil of tobacco is an empyreumatic product, 
obtained by distillation. 

Antagonists and Incompatibles. — The caustic alkalies, tannin, 
iodides, are chemically incompatible. Strychnia is, according to Haugh- 
ton, a true physiological antagonist. Ergot, digitalis, belladonna, am- 
monia, and alcoholic stimulants, antagonize the effects of tobacco on the 
heart and arterial system. 

In cases of poisoning the stomach should be evacuated by emetics, 
or the stomach-pump, and tannin and the iodides should be adminis- 
tered. Ammonia and brandy are indicated to relieve the failing circu- 
lation. Subcutaneous injection of strychnia should also be resorted to, 
and, if necessary, artificial respiration. 

Synergists. — All of the motor depressants increase the effects of 
tobacco. 

Physiological Effects. — Tobacco is a severe and very depress- 
ing nauseant and emetic. It is locally an irritant to the mucous mem- 
brane, and produces burning pain at the epigastrium. It is also laxa- 
tive even when smoked, and in considerable quantity by the stomach 
causes hypercatharsis. The emetic effect of tobacco is doubtless the 
product of three factors : its cerebral action, its local irritation of the 
gastric mucous membrane, and its specific emetic property. The secre- 
tions of the intestinal mucous membrane are increased, and the muscular 
layer is thrown into tetanic contraction, whence the catharsis which 
follows its administration. Applied to a wounded surface, tobacco pro- 
duces the same effects. . 

Its active principle, nicotia, a crystalloidal substance, diffuses into 
the blood with great rapidity. It corresponds, in the mode and inten- 
sity of its action, to prussic acid. In a case narrated by Taylor, a fatal 
result ensued in three minutes after a toxic dose. In another case, 
death occurred in five minutes (M. Fougnies, poisoned by Count Bo- 
carme). When a lethal dose is administered to an animal, the action 






TOBACCO. 479 

of the heart continues after respiration has ceased. Its cavities. are 
usually found empty, or containing black fluid blood. Tobacco is not, 
therefore, a cardiac poison, and the depression of the circulation noted 
when full medicinal doses are administered are doubtless due to the 
interference with the pulmonary functions. Applied directly to the 
muscular tissue of the heart, nicotia does not impair its contractile 
power (Benham). The blood throughout iJie body is black and fluid, 
but as agitation with oxygen restores its color, and as the blood-globules 
are unaffected, the condition of the blood is doubtless due to the arrest 
of oxygenation (asphyxia). 

Trembling and clonic spasms are produced by lethal doses of tobacco. 
Its ultimate effect is paralyzing, but preceding the muscular relaxation 
and paresis there is in animals, and occasionally in man, a definite 
tetanic stage. Death ensues through its paralyzing action on the mus- 
cles of respiration. The end-organs of the motor nerves lose their 
excitability, next the trunks of the nerves, and then the spinal cord, 
but the muscular irritability is unaffected. The brain is not directly 
affected. Giddiness and delirium have been noted in cases of poison- 
ing by tobacco, but these symptoms, as well as the insensibilit}- which 
immediately precedes death, are no doubt due to the accumulation of 
carbonic acid in the blood. The pupils are contracted by tobacco, and, 
in fatal cases, are insensible to light. 

There is considerable sweating, and the skin is cold and clammy in 
fatal cases. The temperature of the body is decidedly reduced (Tsches- 
chichin). The elimination of nicotia probably takes place by the 
kidneys. Very free urinary discharge, at all events, is produced by 
tobacco, and, reasoning by analogy, it may be supposed that this effect 
is due to the direct action of the nicotia on the Malpighian tufts and on 
the tubules of the kidneys. 

When a lethal dose of nicotia has been taken, and the effects follow 
immediately, there may be none of the symptoms described above. In 
the case narrated by Taylor, the "deceased stared wildly ; there were 
no convulsions, and he died quietly [in three minutes], heaving a deep 
sigh in expiring." 

Therapy. — In habitual constipation, due to a relaxed state of the 
muscular layer of the bowel, five minims of the wine of tobacco, admin- 
istered at bedtime, will not unfrequently afford relief. 

Impaction of the caecum, colica pictonum, sometimes intussuscep- 
tion, and strangulated hernia, may be overcome by a tobacco-enema. 
It must be borne in mind, however, that this is an expedient not free 
from danger. Numerous deaths have been caused by it, and Dr. Cope- 
land reports one instance in which thirty grains by enema proved fatal. 
Of the officinal infusion ( 3 j — Oj ) it is not safe to use more than four 
ounces, or fifteen grains ; and this quantity may be expected to produce 
most depressing nausea. It must be urged in favor of this remedy 



480 MOTOR DEPRESSANTS. 

that it has, in very unfavorable cases, proved exceedingly effective. It 
is especially adapted to cases in which obstruction has occurred from 
paresis of the muscular layer of the bowel (impacted caecum, typhlitis, 
painter's colic). 

Tobacco is one of the antispasmodic remedies used in the treatment 
of spasmodic asthma, and the paroxysms of difficult breathing in em- 
physema. It enters as a constituent in various pastilles and cigarettes 
employed in these maladies. Asthmatics unaccustomed to the use of 
tobacco, are sometimes relieved by smoking a cigar or pipe, but the 
effect is lost by habitual use. Laryngismus stridulus may be quickly 
arrested by a snuff-plaster to the neck — an effective but dangerous 
domestic remedy. Obstinate hiccough, or singultus, may be cured by 
five-minim doses of wine of tobacco, but we possess other effective 
remedies, less dangerous and less unpleasant in action. 

We possess no remedy more effective in the treatment of tetanus 
than tobacco. It may be used in the form of an enema, commen- 
cing with four ounces of the infusion, and regulating the quantity to 
be administered and the time of administration by the effect pro- 
duced. Minim-doses of the alkaloid may be given every two hours 
by the stomach, or two minims by the rectum (Haughton). When it 
acts favorably it relaxes the trismus so that nutriment may be taken, 
and suspends the tonic convulsions. Care must be used not to intro- 
duce a lethal quantity, and produce death by asphyxia. The author 
has known the wine of tobacco to be used successfully in a severe case 
of tetanus, the quantity administered being regulated by the effect of 
the remedy on the convulsions. 

The experiments of Haughton having demonstrated an antagonism 
between nicotia and strychnia, he proposed the use of nicotia in strych- 
nia-poisoning, and cases have occurred in which it proved entirely suc- 
cessful. As the effects of nicotia are so nearly instantaneous, the 
stomach administration — if the spasms do not prevent — will suffice, but 
rectal and even hypodermatic injections may be resorted to if neces- 
sary. The following formula of Erlenmeyer may be used for the sub 
cutaneous injection in strychnia-poisoning, and in tetanus : IJ. Nicotia?, 
gr. ss ; aquae destil., 3 ij. M. Sig. Ten minims contain -fa of a 
grain. The cases of strychnia-poisoning in which tobacco was used 
successfully were treated by the infusion. 

Tobacco was formerly employed in the treatment of dropsy. It is 
adapted to those cases in which digitalis is now used. It promotes free 
diuresis, and is at the same time laxative — effects especially serviceable 
in cardiac dropsy. It is, however, so disagreeable in action that few 
practitioners have the temerity to prescribe it, and few patients are 
willing to swallow it. 

There is no doubt that excessive use of tobacco lessens the venereal 
appetite. Slightly nauseating doses of the wine of tobacco will check 



LOBELIA. 481 

chordee and priapism. Satyriasis is effectively quenched in tobacco- 
nausea. Nocturnal pollutions, due to repletion and to continence, are 
also usually suspended by the use of this remedy ; but it is, unfor- 
tunately, so horribly depressing- that the remedy may be justly consid- 
ered the greater evil. 

Local Uses op Tobacco. — So many unfortunate accidents have re- 
sulted from the external application of tobacco, that its use in this way 
is rarely justifiable. The infusion and an ointment have been employed 
with success in tinea, scabies, prurigo, pityriasis, etc. An injection 
of tobacco will destroy ascaricles, but it is unsafe. Other and more 
manageable remedies have entirely taken the place of 'tobacco in the 
local diseases above named. 

Authorities referred to : 

Beniiam, Dr. W. T. On the Action of Nicotine. West Riding Lunatic Asylum lie- 
ports, vol. iv., p. 307. 

Blatin, M. le Dr. Recherche* Phys. it Clin, stir la Nicotine el la Tabac. Gaz. dee 
H'jpitavx, 1870, p. 221. 

Copland, Dr. Dictionary of Practical Medicine, article Colic, vol. i., p. 443. 

Curling, Mr. T. B. A Treatise on Tetanus, London, 1836. 

Erlenaieyer, Dr. A. Die subcidancn Injcclionen der Arzneimittel, 3. Auflage, p. 85. 

Fluckiger and Hambubt, Pharmacographia, English edition, p. 418. 

Haughton, Rev. Prof. Dublin Hospital Gazette, December, 1856, and Dublin Quar- 
terly Journal, August, 1862, p. 172. 

Hermann, Dr. L. Handbuch der exper. Toxicologic, p. 318. 

ITusemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 1142. 

EiRScniTANN, Dr. Abstract in Pull. Gen. de TJterap., lxv., p. 561. 

Hirt, Dr. Ludwig. Die Krankhcilen der Arbeiter, erster Theilf p. 156, et seq. 

Nasse, Dr. 0. Ccntralblatt fiir dierned. Wisscnsch., 1865, p. 785. 

Tardieu, A. Diet. <T Hygiene, deuxieme edition, 1862, article Tabac, p. 229, ct seq. 

Taylor, Dr. A. S. On Poisons, third English edition, p. 803. 

TscHESCHicniN. Arch, fiir Anatomic und Physiologie, 1866, p. 151. 

Traube, Dr. L. As quoted by Hermann. 

UsrENSKT, P. Arch, far Anat. mid Physiologie, 1868, p. 522. 

Van Praag, Dr. L. Arch, fiir Anat. und Phyisologie, viii., p. 56. 

Yon Basch und Oser. Wiener medicinische Jahrbiicher, 1872, p. 387. 

Lobelia. — Lobelia. The leaves and tops of lobelia inflata. Indian 
tobacco. Lobelie enfl'ee, Fr.'; Lobclialcraut, Ger. 

Acetum Lobelia;. — Vinegar of lobelia. (Lobelia, § iv — diluted acetic 
acid to Oij.) Dose, m. v — 3 j. • 

Tinctura Lobelia;. — Tincture of lobelia. (Lobelia, § iv — Oij of 
diluted alcohol). Dose, m. v — 3 j. 

Lobelin. — (Unofficial). A resinoid. Dose, gr. ss — gr. j. 

Composition. — The effects of lobelia are due to the presence in it 
of a peculiar alkaloid — lobelina. This principle is oily in consistence, 
has a pungent, rather acrid taste, a tobacco-like odor, and is strongly 
32 



482 MOTOR DEPRESSANTS. 

alkaline in reaction. It is slightly soluble in water, but more freely 
6oluble in alcohol and ether. It combines with acids to form crystal- 
lizable salts, which are soluble in water and in alcohol. The active 
principle— lobelina — is combined in the plant with lobelic acid. 

Antagonists and Incompatible. — The caustic alkalies decom- 
pose lobelina ; hence these are incompatible. The depressing effects 
of lobelia on the circulation are counteracted by digitalis, belladonna, 
ergot, and other vaso-motor excitants, by alcohol, ether, ammonia, etc. ; 
on the nervous system of animal life, by strychnia, picrotoxine, thebaia, 
etc. 

Synergists. — All of the motor depressants increase the effects of 
lobelia. 

. Physiological Actions. — The taste of lobelia is pungent and acrid, 
ind it persists for a long time in the fauces. The leaves chewed excite 
a very abundant flow of saliva, and soon cause a feeling of epigastric 
depression and nausea, with giddiness and headache. The preparations 
of lobelia administered by the stomach produce, in considerable doses, 
a degree of nausea and depression which amounts to anguish. An 
abundant outpouring of gastric mucus takes place, and vomiting en- 
sues, with great straining and distress. The action of the heart is 
enfeebled ; headache and vertigo are experienced ; a profuse sweat 
breaks out on the surface of the body ; the intestinal canal is relaxed, 
and the discharge of urine is increased. When a lethal dose is taken, 
especially if vomiting do not occur, the effects are chiefly expended on 
the nervous system of animal life. Muscular weakness and trembling, 
shallow respiration, coldness of the surface, feeble circulation, insensi- 
bility, and sometimes convulsions, have occurred. Death ensues from 
paralysis of the muscles of respiration — the action of the heart contin- 
uing after respiration has ceased. The insensibility is doubtless pro- 
duced in the same way as by tobacco, and the cerebral effects are not 
the result of a direct action of the poison. 

According to the investigations of Ott, lobelia, in moderate doses, 
first "increases the blood-pressure by acting as an excitant on the 
peripheral vaso-motor nervous system." This primary' effect is not of 
long duration, a fall in the blood-pressure soon occurs, the peripheral 
circulation is so embarrassed from weakened power of the heart, and 
obstructed pulmonary circulation, that oxygenation of the tissue is rap- 
idly impaired, and a marked reduction of temperature takes place. 
Lobelia affects chiefly the motor nervous system, and especially the 
medulla oblongata and its respiratory centre (nucleus of pneumo- 
gastric). 

Therapy. — Lobelia is much employed by the self-styled physio- 
"medical practitioners as a " sanative agent." The great quantity of 
mucus discharged from the stomach under its emetic action is consid- 
ered by them a proof of its power as an eliminating agent. As an 



LOBELIA. 483 

emetic, lobelia is entirely tooliarsh and depressant to justify its use for 
this purpose. In habitual constipation, dependent on atony of the mus- 
cular layer of the bowel and deficient secretion of the mucous mem- 
brane, good results are sometimes obtained by small doses of the tinct- 
ure — ten minims — administered at bedtime. Impaction of the cae- 
cum, when inflammation has not occurred, may be removed, and the 
bowels induced to act, by small doses, frequently repeated, of the tinct- 
ure of lobelia (two drops every hour). This remedy can be used when 
purgatives would produce serious mischief. An infusion of lobelia as 
an enema has succeeded in relieving strangulated hernia, intussuscep- 
tion, and fecal impactions. This use of the agent is the same as for 
the corresponding administration of tobacco ; it is much safer than 
tobacco, and may be used to produce as decided therapeutic effects. 

Unquestionably the most important application of lobelia is to the 
treatment of the asthmatic paroxysm. It gives relief in a few minutes 
to violent attacks of spasmodic asthma, and it sometimes happens that 
the relief is permanent. Frequent repetition of this remedy in the 
same individual, however, lessens its effects, and it may finally cease to 
afford any relief. To be effective in asthma, a teaspoonful dose of the 
acetum or tincture must be administered every fifteen minutes until 
nausea is induced. Free expectoration and abundant gaseous eructa- 
tions take place, and the breathing soon becomes easy and calm. The 
efficiency of lobelia is increased by the addition of iodide and bromide 
of ammonium. $. Tinct. lobelias, § j ; ammonii iodidi, 3 ij ; ammonii 
bromidi, 3 iij ; syrup, tolutan., 3 ij. M. Sig. A teaspoonful every one, 
two, three, or four hours. 

Whooping-cough, especially after the cessation of the catarrhal 
stage, has been treated successfully by lobelia, but we now possess ether 
agents more effective and less disagreeable in action. Lobelia is, however, 
an excellent expectorant. It is adapted to cases in which the cough is 
dry, resonant, and spasmodic. It succeeds best in those who have at- 
tacks of cough with spasmodic difficulty of breathing, and Who get up 
a little tough mucus after long and painful paroxysms of coughing. 

A lobelia-emetic will cut short an attack of spasmodic croup, but it 
is too harsh and dangerous a remedy to be employed for this purpose. 

Lobelia may be used instead of tobacco in tetanus, strychnia-poison- 
ing, and allied states. 

Authorities referred to : 

Fluckiger and Hanbury. Pharmacographia, p. 357. 

On, Dr. J. Note on the Action of Lobelina on the Circulation. (Reprinted from the 
Boston Medical and Surgical Journal.) 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, p. 438. 
Stille, Dr. A. Therapeutics and Materia Medica, fourth edition, vol. ii., p. 364. 
United States Dispensatory, thirteenth edition. 



484 MOTOR DEPRESSANTS. 

Acidum Hydrocyanicum. — Hydrocyanic or Prussic Acid. Acide 
hydrocyanique, Fr. ; JBlausdure, Ger. 

Acidum Hydrocyanicum Dilutum. — Diluted hydrocyanic acid. " A 
colorless liquid having a peculiar odor, and wholly volatilized by heat. 
It imparts a faint, evanescent red color to litmus, and is not discolored 
by hydrosulphuric acid. With solution of nitrate of silver, added in 
slight excess, one hundred grains of it produce a white precipitate, 
which, when washed with water until the washings are tasteless, and 
dried at a temperature not exceeding 212°, weighs ten grains, and is 
wholly soluble in boiling nitric acid." 

The officinal diluted acid contains two per cent, of anhydrous acid. 
Dose, m. j — m v. 

Antagonists and Incompatibles. — The metallic salts are, gener- 
ally, incompatible ; also the red oxide of mercury and the sulphides. 
Freshly-precipitated oxide of iron (hydrated sesquioxide) has been pro- 
posed as a chemical antidote, but its action is too slow. In cases of 
poisoning, the remedies of the greatest utility are cold affusion to the 
spine, the inhalation of ammonia, the stomach administration, as also 
the intra-venous injection of this substance. Atropia has been pro- 
posed as a physiological antagonist by Preyer ; but the rate at which 
atropia is diffused, as compared with the diffusion of prussic acid, ob- 
viously will render such antagonism powerless, how much soever it may 
be approved on theoretical grounds. The results of experiments, as the 
author and others have shown, are, however, opposed to the existence of 
this antagonism. In addition to these measures, artificial respiration 
should be practised. 

Physiological Effects. — Applied to the unbroken skin, it is 
doubtful whether hydrocyanic acid is absorbed, but in contact with a 
wound or an abrasion, and with the mucous membrane, it diffuses into 
the blood with great rapidity. 

The vapor has a rather fragrant odor, similar to that of bitter-al- 
monds. Inhaled, it has speedily caused death. "When the effects of the 
vapor are short of lethal, giddiness, faintness, embarrassed breathing, a 
weak, small pulse, and great muscular weakness, are produced; and there 
may be even coma and profound insensibility, and yet recovery ensue 
(Taylor). 

In small medicinal doses, beyond a fugitive and very slight calma- 
tive effect, no symptoms are produced by it. When the dose somewhat 
exceeds the medicinal standard, there may occur transient giddiness, 
nausea, faintness, a feeble pulse, and general muscular weakness. The 
effects follow very speedily. When a very large toxic dose is taken. 
a few seconds only intervene from the act of swallowing until its effects 
are manifest, and death may ensue in two minutes or be postponed to 
five. Under these circumstances, the following phenomena have been 
observed : sudden insensibility ; eyes protruding and glistening ; pu- 



HYDROCYANIC ACID. 485 

pils dilated and unaffected by light; extremities cold, relaxed ; the skin 
covered with a clammy sweat ; breathing- convulsive, slow ; the pulse 
extremely feeble or imperceptible ; evacuations involuntary (Taylor). 
When the effects are slower, in consequence of the ingestion of a mere- 
ly lethal dose, there are occasionally tetanic convulsions, opisthotonos, 
trismus, etc. 

Although the effects of prussic acid are exceedingly rapid,. a fatal 
result is not instantaneous. Various acts of volition may be gone 
through, provided but a few seconds are required for their performance. 
Several instructive instances of this kind are narrated by Taylor. The 
effects of hydrocyanic acid are not more rapid than can be accounted 
for by its distribution through the blood. 

Most contradictory opinions have been expressed as to the action 
of prussic acid on the blood : that it at first arterializes and afterward 
arrests decarbonization of the blood ; that it destroys the ozonizing 
power, and does not impair the capacity of the red blood-globules to 
carry and to yield up oxygen; that cyanohgemoglobine is formed by the 
combination of the acid with hamioglobine, and that this combination 
cannot take place, owing to the rapidity of the action of the poison. 
From this chaotic state of scientific opinion the following may be 
evolved : the blood is dark, owing to deficient decarbonization, but this 
is probably due to a spasm of the pulmonary arterioles and paresis of 
the muscles of respiration, whence it follows that rapid asphj'xia en- 
sues. The primary action of prussic acid on the terminal filaments of 
the pneumogastric, as shown by Preyer, is confirmatory of this view. 

Although the action of the heart ceases after respiration, prus- 
sic acid undoubtedly exerts a direct paralyzing action on the cardiac 
ganglia. 

The cerebral effects of this poison are, probably, indirect, the re- 
sult of rapid carbonic-acid poisoning, and the sudden withdrawal of 
oxygen from the cerebral tissues. Direct application of prussic acid to 
the medulla oblongata causes (in the alligator) a sudden and complete 
expiration, and collapse of the lung (Jones). The tetanic convulsions 
which have been observed in many cases of poisoning, in animals and 
in man, indicate a direct action of this agent on the spasm-centre ; but 
the disappearance of the excitability of the motor nerves, and of the 
contractility of muscles which it causes, shows that it quickly exhausts 
the irritability of the spinal cord. These effects on the cord, on the 
nerve-trunks, and on the muscles, are also, probably, in part due tc 
the circulation through them of blood deprived of oxygen and charged 
with carbonic acid. The fact that instances of recovery from a condi- 
tion of profound insensibility are numerous, is confirmatory of the 
view just expressed. Moreover, artificial respiration exerts an undeni- 
able influence over the lethal effects of the acid in animals (Preyer), 
whence it may be concluded that to supply oxygen to the blood is 



486 MOTOR DEPRESSANTS. 

sufficient to arrest all of the symptoms produced by the want of oxygen 
and by the excess of carbonic acid. 

Post-mortem rigidity sets in early after death from prussic acid, and 
is very pronounced. The fingers are tightly closed, the toes strongly 
flexed, the jaws rigid, the eyes prominent and staring. The blood is 
dark-colored, fluid, and the venous trunks and the cerebral sinuses are 
gorged.- 

The quantity of medicinal, diluted hydrocyanic acid necessary to 
produce death will vary with the age, size, and bodily vigor. Habit, 
also, influences to a remarkable degree the susceptibility to its toxic in- 
fluence. A quantity equivalent to forty minims of the diluted hydro- 
cyanic acid (United States Pharmacopoeia) has proved fatal. As the 
effects of a medicinal dose are expended in a half-hour to one hour, the 
repetition of the doses hourly will not be unsafe. Hydrocyanic is not 
a cumulative poison. 

Therapy. — Hydrocyanic is a remedy of very considerable utility in 
certain affections involving the functions of the pneumogastric nerve. 
It is often highly serviceable in various kinds of nervous vomiting ; for 
example, the vomiting of pregnancy, the vomiting which accompanies 
some cerebral disorders, and the reflex vomiting of phthisis. The good 
effects are quickly, if at all, produced ; hence, if no result is attained 
after some days' administration, no advantage can be expected from its 
continued administration. 1$. Acid, hydrocyan. dil., 3j; aquas laur.- 
cerasi, § ij. M. Sig. A teaspoonful every two to four hours. 

G-astralgia, when it is a truly neuralgic affection of the gastric 
aerves, is occasionally very quickly cured by this agent. Sometimes 
cases, apparently in every way suitable for its use, are not improved by 
it. If a few doses do not effect any amelioration, it will be useless to 
continue it. Cases of indigestion accompanied by pain in the nucha, 
and attacks of giddiness (stomachal vertigo), are sometimes remarka- 
bly relieved by prussic acid. Irritative dyspepsia, manifested by these 
symptoms, a red-glazed tongue, pain, epigastric tenderness, and a feel- 
ing of weight and oppression, may be, not unfrequently, much benefited, 
and, indeed, cured ; but while the results are often brilliant, failures are 
also frequent. Enteralgia, a malady often extremely rebellious to 
remedies, not unfrequently yields promptly to prussic acid. 

Considerable medicinal doses of this agent are very fatal to round 
worms (lumbricoides). 

Hydrocyanic acid is a successful remedy in whooping-cough, after 
the subsidence of the catarrhal symptoms. It acts by allaying irrita- 
bility of the pneumogastric, and is successful just in proportion to the 
preponderance of the nervous symptoms. The cases in which the au- 
thor has witnessed the best results were cases of cough by habit, after 
the cessation of the whooping-cough proper. The ?iervous cough of 
mothers, which exists during the presence of whooping-cough in the 



CYANIDE OF rOTASSIUM. 487 

household, may be allayed by this agent. I£. Acid, hydrocyan. dil., 
3 j ; tinct. sanguinaria?, 3 iv ; syrp. senega?, 3 ss ; S)Tp. tolutan., 3 ij ; 
aqua? lauro-cerasi, 3 vij. M. Sig. One or two teaspoonfiils according 
to age, every three or four hours. For irritable cough. It sometimes 
happens that this agent will greatly relieve the cough of phthisis, but 
only when it is chiefly nervous. 

To allay cerebral irritation and excitement, prussic acid has been 
employed with benefit (McLeod). In forty cases of mental disorder ob- 
served by McLeod, there was "slight or temporary amelioration " in 
ten ; a " more decided and permanent effect," the disease being still sta- 
tionary or progressive, in nineteen; and in eight cases, six of acute 
mania, and two of acute melancholia, " the drug has been a factor, and 
a very main one, in rapid restoration to reason." In the treatment of 
these cases, McLeod used from two to five minims of Scheele's dilute 
acid, which contains five per cent, of anhydrous acid. His method of 
administration consisted in giving it at first at short intervals (every 
quarter of an hour), and, when effects were produced, every hour or two. 
He also employed it subcutaneously, in five-minim doses. 

External Uses. — In various cutaneous diseases characterized by 
itching, the local application of prussic acid affords relief. The follow- 
ing formula;, from Fox, represent serviceable combinations : I£. Bi- 
chloride of mercury, gr. j ; dilute hydrocyanic acid, 3 j ; emulsion of 
almonds, § vj. M. Use in itching, in lichen, in the syphilodermata. 
IJ. Dilute hydrocyanic acid, 3 ss to 3 j ; infusion of marsh mallow, § v 
to § viij. M. Use in pruritus. r> . Acetate of ammonia, § j ; dilute 
prussic acid, 3 jss ; infusion of tobacco, § viij. M. Sig. To be sponged 
on the part twice a day in pruritus ani or p. vuh at. $. Borax, 3j; 
prussic acid, 3 ij ; rose-water, 3 viij. M. In the pruritus of old people. 

Authorities referred to : 

Amort, Dr. Robert. The Boston Medical and Surgical Journal, vol. ii., 1866, p. "73. 
Casper, ton Dr. Carl Liman. Gericht. Median., zweiter Band, p. 521. 
Hermann, Dr. L. Lehrbuch der experimcntellcn Toxicologic', Blausaure, p. 288. 
Hoppe-Setler. Archiv fur Path. Anat., Band xxxviii., p. 435. 
Ibidem. Tubinger mcd. chern. Unttr., p. 206. 
Husemann, Dr. Theod. Handbuch, etc., zweiter Band, p. 1136. 
Jones, Dr. Joseph. The Medical Becord, New York, vol. ii., p. 459. 
Kolliker, Prof. Dr. Archiv fur Path. Anat., Band x., p. 272. 
Lecorche et Meuriot, MM. Archives Geiieralcs de Med., tome xi., 6 ser., p. 530, et 
seq. 

McLeod, Dr. Kenneth. The Medical Times and Gazelle, vol. i., 1863, p. 262. 
Preter, Dr. W. Die Blausaure, phys. UntersuchL, Bonn, 1868-"70. 
Taylor, Dr. A. S. On Poisons, third London edition, p. 5S5, et seq. 

Potassii Cyanidum. — Cyanide of Potassium. " In white, opaque, 
amorphous pieces, having a sharp, somewhat alkaline and bitter-almond 
taste, and an alkaline reaction. It is deliquescent in moist air, readily 



488 MOTOR DEPRESSANTS. 

soluble in water when reduced to powder, and sparingly soluble in alco- 
hol." Dose, gr. ■& — gr. $•. 

Antagonists and Incompatibles. — Acids decompose it and set 
free hydrocyanic acid. As respects its physiological properties, its an- 
tagonists are the same as those of hydrocyanic acid. 

Synergists. — Same as for hydrocyanic acid. 

Physiological Actions. — The effects of this salt have been already 
mentioned in sufficient detail in the preceding article, so far as they 
correspond to hj'drocyanic acid. It has, however, some special physical 
properties which separate it slightly from the powerful agent which en- 
ters into its composition. 

Applied to the unbroken epidermis, the cyanide of potassium pro- 
duces at first a sensation of coldness, followed by tingling and itching, 
and in a half-hour the skin is found to be somewhat reddened. Pro- 
longed contact produces a phlyctenular or eczematous eruption. 

Systemic effects are produced by the local and external use of the 
cyanide of potassium, viz., slowing of the pulse and respiration, mus- 
cular weakness, drowsiness, and coldness. Lethal effects may follow 
prolonged contact with the skin, even when the epidermis is unbroken. 
Applied to a wound or abraded surface this salt causes a burning pain, 
excites a high degree of inflammation, and produces prompt lethal 
effects. 

Therapy. — Cyanide of potassium may be prescribed as a substitute 
for hydrocyanic acid in all of the maladies for which the latter is used. 
This salt has, however, some special applications, which we owe to 
Trousseau. This eminent observer has shown that a solution of the 
cyanide applied to the seat of painful sensations gives great relief in 
various forms of reflex headache, gastric, cardiac, pulmonary, and men- 
strual. The headache which accompanies the pyretic state is, accord- 
ing to the same authority, cured or greatly alleviated by the cyanide 
solution, while at the same time a favorable influence is exerted over 
the temperature. 1$. Potassii cyanidi, gr. x — 3j; aquas lauro-cerasi, 
| iv. M. S. A compress, moistened with the solution, to be applied 
to the seat of pain. From a quarter to a half hour of contact with the 
skin usually suffices. 

A solution of the cyanide of potassium, of the strength given above, 
will remove the stains of nitrate of silver, and also the dissecting-room 
odor, from the hands. 

Cyanide of potassium, in the form of ointment or solution, is an ex- 
cellent remedy for allaying irritation in various cutaneous diseases. In 
pruritus and urticaria, the following formula (McCall Anderson) gives 
relief : tj . Potassii cyanidi, gr. vj ; pulv. cocci, gr. j ; ung. aq. rosae, 
|j. M. Sig. Ointment. In eczema, with pruritus, the same authority 
recommends the following: ^. Potassii cyanidi, gr. v; sulphuris, 
potassii bicarb., aa 3ss; pulv. cocci, gr. v j ; axungia?, §j. M. Sig. 



NITRITE OF AMYL. 489 

Ointment. A solution of the cyanide of potassium is one of the most 
effective applications for that very troublesome disorder, pruritus pu- 
dendi. fy. Potassii cyanidi, gr. xv ; aquas lauro-cerasi, § viij. M. 
Sig. Lotion. This formula is also serviceable in lichen and prurigo 
(Hardy). 

Entomologists make use of the cyanide to destroy insects without 
injuring their structures. One part of the cyanide, two parts of plaster 
of Paris, and one and a half part of water made into a paste and poured 
into a wide-mouthed bottle, sets into a solid mass, which gives off the 
vapor of lrydrocyanic acid (Squire). 

Authorities referred to : 

Trousseau et Pidoux. Traite de TMrapeutique, etc., vol. ii., p. 265, et scq. 
Tkousseau, A. Clinique Medicate, vol. ii., p. 332. 

Amyli Nitritum. — Nitrite of Amyl. (Unofficial.) Nitrite d'amyle, 
Fr. ; Amylnitrit, Gr. 

Properties. — A yellowish or reddish-yellow liquid, rather oily in 
consistence, very volatile, and having a peculiar and very diffusive 
ethereal odor. It may contain, as impurities, nitric acid, amylnitric 
ether, amylvalerianic ether, and hydrocyanic acid. The specific gravity 
is .877. Dose, m. ij — m. v, by inhalation. 

Antagonists. — The actions of the nitrite of amyl are antagonized by 
all those agents which increase the functional activity of the spinal cord 
and sympathetic — as strychnia, brucia, picrotoxine, digitalis, ergot, bel- 
ladonna, etc. . This antagonism may not be available, owing to the 
difference in the rate at which they are diffused, to affect the system. 

Synergists. — All of the motor depressants increase the effects of 
the nitrite of amyl. 

Physiological Actions. — The following are the symptoms pro- 
duced by nitrite of amyl when inhaled : acceleration of the action of the 
heart ; sudden flushing of the face ; dilatation of the arterioles in con- 
sequence of paresis of the muscular layer of these vessels ; a sense of 
extreme fullness of the brain, with vertigo ; fall in the blood-pressure ; 
lowering of the temperature ; complete resolution of the muscular sys- 
tem of animal life. The vapor of nitrite of amyl applied directly to the 
tissues — muscular or nervous — suspends or completely arrests func- 
tional activity. Circulating in the blood, it undoubtedly affects most 
the vaso-motor nervous system and unstriped muscular fibre. 

The marked acceleration of the heart (Pick) is in part consecutive, 
doubtless, to the sudden dilatation of the arterioles, permitting such an 
increased quantity of the blood to enter these vessels as to require 
renewed effort on the part of the heart to supply it ; in part, also, to 
the paretic state which it induces in the inhibitory apparatus. The 
great fall in the blood-pressure noted by Brunton, Wood, and Amez- 



490 MOTOR DEPRESSANTS. 

Droz, is also due to dilatation of the arterioles, and consequent diminu- 
tion of tension in the peripheral vascular system. Dilatation of the 
retinal vessels, when nitrite of amyl is inhaled, has been ascertained by 
ophthalmoscopic examination (Aldridge). 

On the nervous system of animal life the nitrite of amyl acts as a 
depressant — impairing motility first, and at the last, sensibility. It 
affects both the spinal cord and the nerves, lessening the sensibility to 
all forms of irritation, and diminishing the reflex functions. It also 
impairs the contractility of muscle. Death ensues from failure cf respi- 
ration, and the cerebral functions are unaffected until carbonic-acid poi- 
soning ensues. 

Decided lowering of temperature is produced by the nitrite of amyl. 
This result is no doubt due to the action of this agent on the hsemo- 
globine, whereby the carrying capacity of the red blood-globules of oxy- 
gen is lessened (Gamgee), metamorphosis of tissue is interfered with, 
and the generation of animal heat is diminished. A peculiar change 
ensues in the color of the blood as a result' of the lessened oxygenation : 
all the blood of the body assumes a modified venous hue. 

A curious fact has been noted by Hoffman, viz. : the hypodermatic 
injection of lethal doses of nitrite of amyl produces in rabbits a tem- 
porary glycosuria. 

Therapy. — The applications of the nitrite of amyl in the treatment 
of disease have been deduced from a study of its physiological actions. 
It is especially indicated when morbid symptoms result from vaso-motor 
spasm. It has been shown that epileptic attacks may be warded off by 
the inhalation of nitrite of amyl, at the beginning of the movement of 
the aura. Patients who have a distinct w r arning of the seizures should 
be constantly provided with a small quantity of this remedy in order to 
practise the inhalation whenever an attack is impending. The mechan- 
ism of the action is very simple : the vaso-motor spasm of the cerebral 
vessels, which is the initial symptom of an epileptic convulsion, is re- 
laxed, and the vessels dilated by the nitrite of amyl. 

An attack of migraine of that form characterized by vaso-motor 
spasm (pallor of the face) maybe quickly relieved and sometimes abort- 
ed by the inhalation of two or three drops of amylnitrite. "When there 
are redness of the face, injection of the conjunctivas, and fullness of the 
cerebral vessels, this remedy is contraindicated. 

Asthma, when purely spasmodic, is usually quickly checked by this 
remedy. The paroxyms of difficult breathing which accompany em- 
physema and cardiac disease are not relieved in this way ; indeed, the 
author has known the most serious distress to be produced by the in- 
halation under these circumstances. 

Exaltation of the reflex function of the spinal cord and muscular 
spasm are morbid states in which good results may be expected from 
inhalation of the nitrite of amyl. It has been used with success in 






NITRO-GLYCERINE. 491 

tetanus. It should also be fairly tried in strychnia-poisoning and in 
hydrophobia. 

Most signal relief has been obtained from the inhalation of amylni- 
trite in angina pectoris. We owe this important suggestion and prac- 
tice to Brunton, who had ascertained tliat when the paroxysm of angina 
pectoris occurs, a great rise of arterial tension takes place. When the 
pain, precordial distress, and anxiety are felt, there should be no delay 
in the use of the remedy. Some cautions are, however, needed. It 
may be unsafe when advanced degeneration of the cerebral vessels ex- 
ists (Anstie). Fatty degeneration of' the heart, which is so frequently 
a cause or an accompaniment of angina pectoris, may also render the 
use of so powerful a paralyzer of doubtful expediency. 

Dr. Mary Putnam Jacobi has found the inhalation of nitrite of 
amyl very servicable in neuralgic dysmenorrhea. On theoretical 
grounds this agent was proposed for the relief of cholera asphyxia 
(Brunton, Gamgee), but the trials thus far made with it have demon- 
strated its inutility. Owing to the fact, shown by Gamgee, that nitrite 
of amyl combines with haemoglobine, Brunton proposes that this remedy, 
if given at all in cholera, must be administered by the stomach cr by 
subcutaneous injection, and not by inhalation. 

Repetition in the use of the nitrite of amyl diminishes its effects, 
and hence increasing doses are necessary wdien it is often employed in 
the same case. 

Authorities referred to: 

Aldridge, Dr. Charles. The West Riding Lunatic Asylum Medical Reports, vol. i., 
p. 97. 

Amez-Droz, Dr. Archives de Physiologie Kormale et Pathologique, 1873, p. 467. 

Anstie, Dr. F. E. Transactions of Clinical Society, Lancet, March 5, 1870. 

Brunton, Dr. T. L. The British Medical Journal, July 13, 1872. Ibid., Tlie Lancet, 
July 27, 1867. 

Gamgee, Dr. Arthur. Philosophical Transactions, 1868, p. 589. 

Haddon, Dr. John. Edinburgh Medical Journal, July, 1870, p. 45. 

Jacobi, Dr. Mart Putnam. The Medical Record, New York, January 15, 1875. 

Mitchell, Dr. S. Weir. The Philadelphia Medical Times, vol. v., p. 553. 

Wood, Dr. H. C. American Journal of the Medical Sciences, July, 1871. 

Nitro-Glycerinum. — Nitro-glycerine. 

Peoperties. — Nitro-glycerine is an oily liquid, colorless, or pale 
yellow, and has the specific gravity 1.60 at 59° Fahr. It burns quietly 
in the open air, but heated in a close vessel, or subjected to percussion, 
it explodes violently. It decomposes if long kept. It is very slightly 
soluble in water, but dissolves freely in alcohol and in ether. The best 
prejjaration for administration is the alcoholic solution — one part of 
nitro-glycerine to one hundred parts of alcohol. The dose of this ranges 
from one minim to many minims. As the susceptibility to this agent 
varies greatly, the initial dose should be the smallest. One minim of 



492 MOTOR DEPRESSANTS. 

the one per cent, solution will give some persons violent headache, 
while others may take a minim of the unmixed drug without any de- 
cided effect. 

It should not be forgotten that the alcoholic solution will explode 
if struck with a wet hammer. 

Antagonists. — All those agents which increase the reflex activity 
of the spinal cord, and stimulate the vaso-motor system, as strychnia, 
ergot, digitalis, belladonna, etc., antagonize nitro-glycerine. 

Synergists. — Amyl nitrite acts very similarly, and the motor de- 
pressants in general, promote the actions of nitro-glycerine. 

Physiological Actions. — The taste of nitro-glycerine is at first 
sweetish, but this impression is followed by aromatic pungency. In a 
few minutes — from three to five — after a small medicinal dose, there 
are suddenly experienced a feeling of giddiness, tension of the head, 
with fullness, languor, nausea, and sometimes stomach-pain. Such 
effects are experienced from a small dose, if the individual taking it, 
is susceptible. It follows, then, that the quantity of nitro-glycerine 
causing such symptoms must vary in different patients. Dr. Harley 
experienced these effects after taking fifteen drops. Dr. Fuller ex- 
perienced some fullness of the head, perspiration, intermittent pulse,' 
and some after-headache, from a dose equivalent to fifty minims of a 
one-per-cent. solution, or a half -drop of the nitro-glycerine itself (Mur- 
rell). In some persons a drop or two of the one-per-cent. solution will 
cause dizziness, faintness, a rapid and very weak pulse, perspiration of 
a rather clammy character ; or, indeed, the symptoms may proceed to 
unconsciousness. Dr. Murrell applied the moistened cork of the bottle 
containing the solution to his lips, and in a few minutes experienced a 
tremendous action of the heart and arterial system ; his pulse rose to 
100 and higher, and he had " a splitting headache " for some time. 
There is no change in the temperature. "Women and the feeble in 
constitution suffer more decided effects than the robust. Drowsiness 
comes on, with a feeling of languor, in those on whom the smallest 
dose acts kindly. With the rapid pulse is a considerable degree of 
dicrotism. The change in the character of the pulse begins in about- 
six minutes after the dose is taken, and lasts on the whole about one 
hour. The sphygmographic tracings appended to Dr. Murrell's paper 
are remarkable for the extent of the excursions of the lever, the abrupt 
ascent, the sharpness of the summit, and the dicrotic rebound, indi- 
cating an extremely low state of the arterial tension. "When the 
heart of a frog is put into a '75-per-cent. salt solution, and two drops 
of a ten per cent, solution of nitro-glycerine are added, the heart acts 
more and more slowly, and presently stops. An alcoholic solution has 
no effect (Brunton). When injected into the jugular vein of a cat, 
the niti'o-glycerine solution arrests the heart speedily. That the vagus 
is paralyzed, and the inhibition thus removed from the heart, is proved 



NITRO-GLYCERINE. 493 

by the fact that galvanic excitation of the vagus has no effect in re- 
straining the cardiac movements. Changes occur in the blood like 
those induced by amyl nitrite and the nitrites of soda and other nitrites ; 
that is, the blood assumes a chocolate-color, and probably loses its 
power of absorbing and conveying oxygen, but its so-called ozonizing 
function may not be interfered with, since nitroglycerine does not pre- 
vent the guaiac reaction, in which respect it agrees with the other 
nitrites. The change in the color of the blood is produced slowly 
when blood is shaken up with some nitro-glyccrine outside of the body 
(Brunton). 

In frogs nitro-glycerine causes weakness, tetanus, ending in paral- 
ysis ; but, in warm-blooded animals, there are convulsive movements, 
as twitching of the muscles, hiccough, spasmodic breathing, etc. The 
tetanus in frogs, according to Brunton, is not due to a direct action of 
the poison on the spinal cord, thus opposing the assumption of Minor, 
who held that it acts on the medulla. The paralyzing effect of nitro- 
glyccrine appears to be due to an action on the muscles, and also on 
the motor nerves. "When it is applied directly to the muscles they 
quickly lose their contractility. The reflex function of the cord is 
extinguished first in the parts external to the cranium, the cerebral 
nerves preserving their power to transmit impressions till later. Sen- 
sation is destroyed by it as well as motility. Death is due to asphyxia 
— to paralysis of the muscles of respiration. Notwithstanding the 
activity of nitro-glycerine, the most serious symptoms are recovered 
from without detriment. Thus Dr. Murrell narrates several cases in 
which unconsciousness was produced without any ill results, except 
some temporary headache. 

Therapy. — Nitro-glycerine is adapted to the treatment of the mala- 
dies in which its congener, amyl nitrite, has proved so effective. It has 
the advantages over the latter of being more permanent, more readily 
administered, and more sustained in action. In sea-sickness, reflex 
vomiting, gastralgia, hepatic colic, and other painful and spasmodic 
affections of the digestive tube, it may afford very prompt relief. It 
was first employed in the treatment of angina pectoris, in which it 
gives as much relief as does amyl nitrite, but the latter should be pre- 
ferred when the utmost promptitude of action is' necessary. The form 
of the disease requiring this medicine is that characterized by high 
tension of the peripheral vessels, which is, doubtless, the condition in 
the genuine cases of angina pectoris. Very prompt relief may be 
given to attacks of hiccough by this medicine. Some cases of sp)as- 
modic astJima are much benefited by it. The less there is of struct- 
ural alterations the more certain the relief. As the secretions of the 
mucous membrane of the respkatory tract are increased by it, the 
cases with deficient secretion are those most certain to be benefited. 
It should be carefully tried in whooping-cough and in laryngismus 



494 MOTOR DEPRESSANTS. 

stridulus. There is much to be expected from nitro-glycerine in dis- 
eases of the nervous system characterized by heightened reflexes. An 
attack of epilepsy may be aborted by its timely administration. By 
preventing the spasm of the vessels and consequent sudden anaemia of 
the brain, the first and most important event in the series cannot occur. 
It should be fairly tried in tetanies and hydrophobia. In neuralgia of 
the fifth nerve it has given immediate relief in numerous instances. 
It is the most appropriate remedy in that form of migraine, or sick- 
headache, in which the vessels are in a condition of spasm, but is not 
proper in those cases having a flushed face from dilated vessels. 

The cold stage of an intermittent may be aborted by the timely 
administration of nitro-glycerine. It promises to be especially useful 
in the pernicious malarial diseases to prevent the dangerous depression 
of the cold stage. In these cases its administration should be so timed 
that the physiological effect of the remedy occur at the onset of the 
cold stage of the disease. The mechanism of its curative action is 
obvious. Remarkable results have lately been obtained from this 
remedy in acute and chronic Brighfs disease (Robson). It is well 
known, of course, that high arterial tension is present, but whether 
as causative of the renal changes, or a consequence of them, is not 
known. The apparently constant association of degenerative changes 
in the renal ganglia with the lesions of Bi-ight's disease, discovered by 
Ba Costa and Longstreth, would indicate that the state of the vessels 
is a factor in developing the structural alterations. The manner in 
which nitro-glycerine affords relief, and possibly effects a cure, is thus 
fully explained. Indeed, all of the curative results obtained from nitro- 
glycerine must be referred to its action on the vascular apparatus. 

Authorities referred to : 

Brunton, T. Lauder. St. Bartholomew's Hospital Reports, vol. xii., p. 140. Prelimi- 
nary Notes on the Physiological Action of Nitro-glycerine. 

Mixor, Dr. A. J. Journal of Nervous and Mental Diseases, vol. iii., p. 355. 

Murrell, Dr. William. The Lancet, 1S79, pp. 80, 113, 225. 

Robson, Mr. Mayo. Tlic British Med. Journal, November, 1880, p. 803. 

Aconitlim. — Aconite. Aconiti Folia. Aconite-leaves. Feuilles 
d'aconit, Fr. ; EisenJiutJcraut, Ger. 

Aconiti Radix. — Aconite-root. Racine d'aconit, Fr. ; Eisenhut- 
knollen, Ger. 

The leaves and root of aconitum napellus. The Indian aconite-root, 
or bish, is supposed to be more powerful than the root of A. najiellus, 
and is preferred for the manufacture of aconitia (Fliickiger and Han- 
bury). 

Extraction Aconiti. — Extract of aconite. Prepared from the leaves. 
Bose, gr. \ to gr. ss. 



ACONITE. 495 

Linimentum Aconiti. — Liniment of aconite (aconite, glycerine, 
alcohol). For external use only. 

Tinctura Aconiti Madicis. — Tincture of aconite-root. Dose, m. j 
— m. v. 

Composition. — The principal alkaloid is aconitia or aconitine, which 
exists in two forms, crystalline and amorphous, and forms with acids 
crystallizable salts. The crystalline form of aconitia is soluble in chloro- 
form, ether, and alcohol. Aconite contains also another alkaloid 
which has received various designations — pseudo-aconitine, napelline, 
nepalline, etc., which is closely allied to aconitia. and is found in com- 
merce under this name. It is but slightly soluble in chloroform, ether, 
and alcohol, and it exists also in two forms, crystalline and amorphous. 
Besides the foregoing, another base has been discovered, to which the 
name napelline has also been given. This is an amorphous alkaloid, 
having strong basic properties, soluble in water, chloroform, and alco- 
hol, but not soluble in ether. 

These basic substances are united with a peculiar acid — aconitic acid. 

Antagonists and Incompatibles. — Alcohol, ether, ammonia, turpen- 
tine, digitalis, heat, etc., antagonize the actions of aconite. In cases of 
poisoning, the stomach should be evacuated, stimulants administered by 
the stomach and rectum, and external warmth applied. Digitalis has 
been used with considerable advantage (Fothergill). The intra-venous 
injection of ammonia maybe practised, and artificial respiration resorted 
to. To overcome the depression of the heart's action, which is the 
capital point, the hypodermatic injection of atropia is indicated. As 
the chief danger consists in failure of the heart's action, the recumbent 
position should be strictly maintained. 

Synergists. — All the agents of this group increase the effects of 
aconite. Cold, fatigue, and all depressing emotions, are also syner- 
gistic. 

Physiological Actions. — A drop of tincture of aconite placed on 
the tongue excites a warm and pungent sensation, followed by persist- 
ent tingling and numbness. Prolonged contact with the skin causes 
similar effects upon the sensory nerves. During the medicinal adminis- 
tration of aconite in considerable doses, irritation and a sense of constric- 
tion of the fauces are experienced. Large medicinal doses produce 
gastric pain, nausea, and even vomiting. When the gastro-intestinal 
mucous membrane is in an irritable state, aconite impairs the appetite, 
hinders the digestion, and causes diarrhoea, and in the normal state of 
the membrane increases its secretions and hastens the peristaltic move- 
ments. 

The systemic effects of aconite follow within a half-hour after its 
administration. The number and force of the heart-beats are reduced, 
and the arterial tension is lowered. The action of the skin is increased, 
and a more abundant urinary discharge takes place. If the quantity 



496 MOTOR DEPRESSANTS. 

has been a full medicinal dose, some muscular weakness, tingling in the 
tongue, lips, and extremities, are also experienced. The whole duration 
of the effect is about three hours. When a lethal dose is swallowed, 
the symptoms begin in from five minutes to a half-hour. In a medical 
student, who swallowed by mistake a teaspoonful of the tincture of the 
root, the symptoms began after he had reached the college, having 
walked from his quarters — the time being about twenty minutes. He 
experienced an overpowering sense of fatigue in the lower extremities, 
and he felt, also, great muscular weakness. His eyesight became dim, 
the globes rather prominent, the pupils dilated. He experienced great 
dyspnoea, and his respirations were shallow and labored. The pulse 
was at first slow and small, and at last became imperceptible. The 
surface of the body, the tongue, and breath, were cold. The skin was 
covered with a profuse sweat. He was restless, anxious, and sighed 
frequently; but he had no stupor or convulsions. There were also 
decided numbness and tingling in the extremities, and in the tongue 
and lips. Tactile impressions were very faint, and the sense of pain 
was greatly reduced, so that he seemed almost unconscious of irritants. 
His temperature fell 2° Fahr. Under the use of heat, brandy, and 
ammonia, he revived in the course of six hours, and, on the following 
day, although weak, there were no indications of the effects of the 
poison. 

Aconite affects the sensory nerves before the motor. It paralyzes, 
first, the end-organs, next the nerve-trunks, and finally the centres of 
sensation in the cord. Aconite also impairs the reflex function of the 
spinal cord; but this effect is, doubtless, secondary to the sensory 
paralysis. The power of voluntary movement continues after the cessa- 
tion of the reflex functions ; but it is finally lost. The arrest of motil- 
ity is due to the action of the poison on the motor centres of the cord, 
and subsequently on the nerve-trunks. 

Aconite, applied directly to the heart, lessens the number and force 
of its beats, and finally arrests its action in the diastole. The cardiac 
muscle, after the cessation of its movements, does not respond to gal- 
vanic excitation. Aconite lowers the arterial pressure, as well as les- 
sens the force of the heart-beat. From these facts it may be concluded 
that it is a direct cardiac poison affecting its ganglia and muscle, and 
also a sedative to the vasor-motor nervous system. It is also a respira- 
tory poison, in virtue of its paralyzing action on the muscles of respi- 
ration; but the action of the heart ceases before the respiratory move- 
ments. 

Aconite increases elimination by the skin and kidneys. With in- 
creased discharge of water, there takes place, also, increased excretion 
of solids. 

Therapy. — The monopoly bj r homoeopathic practitioners of the use 
of aconite has aroused a prejudice against it, which has discouraged its 



ACONITE. 497 

employment. Aconite is, however, an antagonist to the fever-pro- 
cess; it is not applicable in accordance with the so-called law of simi- 
lars. It is used by these quacks because it is a powerful agent which 
will produce manifest effects in small doses, that may easily be dis- 
guised. 

The author can quite agree with Dr. Ringer in the statement that, 
aconite is a very valuable medicine, in the class of cases to which it is 
adapted. It lessens the pulse-rate, lowers arterial tension, diminishes 
abnormal heat; it therefore antagonizes that condition of the organism 
known as fever. As it also slows the respirator}' movements, and thus 
lessens the amount of work done by the breathing-apparatus, it is espe- 
cially indicated in inflammatory states of the respiratory organs. As 
it diminishes the sensibility of the sensory nerves, it is useful in certain 
forms of neuralgia?. As it induces muscular weakness and lowers the 
activity of the reflex functions, it is indicated in morbid states charac- 
terized by an excess of motor activity. 

Tonsillitis, acute pharyngitis, ulceration of tonsils, when accom- 
panied by fever and elevated arterial tension, are greatly relieved by 
the use of the tincture of aconite. From a half-drop to one drop every 
half-hour, until an impression is made on the fever-movement, and then 
every hour or two, is the best mode of administration. In acute catarrh 
(nasal and faucial), acute otitis, and in acute catarrhal bronchitis, the 
best results may be obtained by the use of aconite, as above described. 
The author's observations entitle him to speak with confidence of the 
good effects of this remedy in catarrhal and fibrinous pneumonia. It 
is more especially serviceable before exudations have taken place, but is 
not without utility at any stage, provided the inflammatory process con- 
tinues. It not only abates the symptoms, but it favors the removal of 
the products of inflammation, by increasing elimination through the 
skin and kidneys. The use of aconite is not incompatible with the em- 
ployment of other measures which may be needed; but, generally, in 
fibrinous pneumonia, aconite is sufficient up to the period of crisis. The 
author has witnessed excellent results from the use of aconite in small 
doses frequently repeated (one drop every hour) in lowering the tem- 
perature of phthisis, especially when new districts of pulmonary tissue 
are invaded by pneumonitis. For the treatment of acute pleuritis, pre- 
vious to the stage of effusion, no remedies are more effective than aco- 
nite and opium. ]J. Tinct. aconiti rad., 3 ij ; tinct. opii deodor., 3 vj. 
M. Sig. Eight drops in xoater every hour or two. If the pain is 
severe, a larger dose of opium should be administered, when the effect 
can be maintained by the quantity directed in the above prescription. 

Overaction of the heart, with hypertrophy and without valvular 
lesion, especially if there be present a condition of plethora, is bene- 
fited by a quantity of aconite sufficiently large to moderate the cardiac 
movements. 

33 



-198 MOTOR DEPRESSANTS. 

Aconite is contraindicated in inflammatory states of the gastroin- 
testinal mucous membrane. It is very serviceable in acute congestion 
of the liver and hepatitis : it diminishes the fever, and, by causing free 
transpiration, lessens the pungent heat of the skin. Peritonitis is best 
treated by a combination of aconite and opium, as described above for 
, pleuritis. Generally, the opium needs to be given in somewhat larger 
quantity in peritonitis than in pleuritis. In pelvic peritonitis, puer- 
peral metritis and peritonitis, aconite is indicated, and is of unques- 
tionable utility, provided there be present a condition of sthenic reac- 
tion. A condition of adynamia, on the other hand, always contraindi- 
cates the use of aconite. 

The simple fevers of childhood, febricula, ephemeral fever, arising 
from various causes, as cold, fatigue, excitement, etc., are best treated by 
small and repeated doses of aconite. The remedy induces sweating, 
and then the fever-movement subsides. The hot stage of interrnittents 
and remittent fever, if any febrifuge is required, may be relieved of its 
intensity by frequently-repeated doses of aconite. The continued fevers 
are not benefited by this remed}'- unless a condition of hyperpyrexia is 
threatened, when aconite may be used in connection with other anti- 
pyretic remedies. 

Aconite possesses the highest value in the eruptive fezers, especially 
in scarlet fever. There are two conditions of this disease especially 
requiring the use of aconite — the eruptive stage, and the period of des- 
quamation, if, as is usual, a marked rise of temperature takes place at 
this .period of the disease. Several important purposes are subserved 
by the use of this remedy ;■ it lowers the fever-heat, favcrs the action 
of the skin and kidneys, and checks the nasal, faucial, and aural inflam- 
mations, which constitute such troublesome complications and sequelae. 
The particular utility of aconite in measles consists in its power to ar- 
rest the catarrhal pneumonia, one of the most serious complications of 
this disease. We have no remedy more useful in erysipelas — idio- 
pathic, so called, and not arising from trauma ; but, on the other hand, 
Ringer describes an apparently erysipelatous inflammation following 
vaccination, which is quickly cured by aconite. According to the au- 
thor's observations, it is facial erysipelas which is most decidedly bene- 
fited, and cases characterized by sthenic reaction. When there is a 
state of adynamia present, the eruption being dusky and the cutaneous 
circulation languid, belladonna is preferable to aconite. When, in acute 
rheumatism, there are much heat and a dry skin, instead of the usual 
sweating, aconite is very serviceable. It affords very considerable relief 
in muscular rheumatism when there is much fever. 

In acute inflammation of the cerebral and spinal meninges, and in 
cerebro-spnnal meningitis before effusion has taken place, aconite is as 
serviceable as in other acute inflammations. It is generally advisable 
to combine opium with it, especially in cerebro-spinal meningitis. In 



VERATRUM VIRIDE. 499 

acute maniacal delirium, and in mental disorders generally, when there 
is much motor activity, with vascular excitement and increased arterial 
tension, aconite is useful, but is not so effective as gelsemium. Aconite 
renders important service in the active form of acute cerebral congestion. 

Neuralgia, when accompanied by arterial excitement and muscular 
spasm, is relieved by aconite ; but generally the neuralgias are much 
more successfully treated by hypodermatic injections and galvanism. 

It is asserted by Ringer, and also by Phillips, that sudden suppres- 
sion of the catamenial flow, caused by cold, can be relieved by aconite, 
in drop-doses of the tincture every half-hour or hour. The author can 
assert that this remedy has a high degree of utility in congestive dys- 
menorrhea, occurring in plethoric subjects. These are cases, also, in 
which gelsemium is so undoubtedly beneficial. 

Aconitia in Trigeminal Neuralgia. — Remarkable results have lately 
been obtained by the use of Duquesnel's aconitia in this malady. The 
following formula is proposed by the New York Therapeutical Society; 
R. Aconitia (Duquesnel's) gr. -j^, Glyoerinae, Alcohol., aa 3 j, Aquas 
Menthas Pip. ad 3 ij. M. Dose — A teaspoonful. The dose is some- 
times very slowly and cautiously increased to \. Although it does not 
succeed in all cases of tic douloureux for obvious reasons, it relieves 
remarkably in others. (Seguin). 

Authorities referred to : 

Achscharumow, Dr. Arehiv fur Anat. und Physiologie, 1866, p. 255. 

Bohm and Ewers. Ueber diephys. Wtrk., etc., Arehiv far experimentelle Paihologie 
und Pharmakologie, 1873, p. 385. 

Fothergill, Dr. J. M. Tlie British Jfcdical Journal, 1870. Ibid., January 17, 1874. 

Hottot, M. Journal de VAnatomie cl de la Physiologie, 1864, p. 113. 

Husemann, Drs. Theodor und Aug. Pjlamenstoffe, p. 210. 

Husemann, Dr. Theodor. Handbuch der gesammlen Arzneirniitellehre, p. 1153. 

Liegeois et Hottot. Ibid., 1861, p. 520. 

Phillips, Dr. C. D. F. The Practitioner. Ibid., Materia Jfediea and Therapeutics, 
1874, p. 2. 

Ringer, Dr. Stdxey. Handbook of Therapeutics, article Aconite. 

Taylor, Dr. A. S. On Poisons, third London edition, p. 747. 

Van Praag, Dr. L. Arehiv fur path. Anal., vii., p. 43S. 

Veratrum Album. — White hellebore. 

Veratmm Viride. — American hellebore. 

Extraction Veratri Viridis Fluidum. — Fluid extract of veratrum 
viride. Dose, m. ij — m. v. 

Tinctura Veratri Viridis. — Tincture of veratrum viride. Dose, 
m. ij — m. v. 

Veratria. — Veratria. "Is pulverulent, grayish-white, inodorous, 
but very irritant to the nostrils. It has an acrid, bitter taste, causing a 
sensation of tingling with numbness in the tongue. It is very slightly 
soluble in water, but readily and wholly dissolved by alcohol. It has an 
alkaline reaction." 



500 MOTOR DEPRESSANTS. 

Unguentum Veratrice. — Veratria-ointment. (Veratria, 3j; lard, 

Composition. — Verafcrum album, veratrum viride, and veratrum 
sabadillae, correspond closely in chemical composition, and the first 
two in botanical characteristics. Sabadilla is only used as the source 
of the alkaloid, veratria. The alkaloids of veratrum album are jervia 
and veratralbia (Mitchell). Veratrum viride contains two alkaloids 
also — -jervia and veratroidia. The alkaloid jervia, as found in both 
plants, is the same in chemical action and in physiological effects, and 
may therefore be considered identical. There are very close affinities 
between the veratralbia of Mitchell and the veratroidia, first discovered 
by Bullock, but they are not the same ; they differ as respects their 
chemical relations, and also in physiological properties — veratralbia 
being much more powerful than jervia and veratroidia. Veratrum 
album and veratrum viride contain abundance of soft resin, which, when 
pure, is nearly, if not quite, inert. As the alkaloid jervia is with dif- 
ficulty separated from the resin, it is probable that the physiological 
activity, ascribed to the resin by some observers, is really due to the 
presence of the alkaloid. 

Antagonists and Incompatibles. — The effects of veratrum viride 
on the heart are counterbalanced by alcoholic stimulants, opium, and 
ammonia. When dangerous symptoms are produced, the recumbent 
position should be enforced, alcoholic stimulants should be administered 
by the stomach and rectum, and dry heat should be applied to the body. 
Ammonia may also be given by the stomach or by intra-venous injec- 
tion, and, if nausea and vomiting persist, morphia may be administered 
subcutaneously. The tincture of opium, in stimulant doses, may be pre- 
scribed with the alcoholic stimulants. 

Syneegists. — The vaso-motor depressants, tobacco, lobelia, aconite, 
etc., are synergistic. Bloodletting, haemorrhage, purgatives, and all 
agencies which diminish vital power, increase the effects of veratrum. 

Physiological Effects. — In the remarks which follow, veratrum 
viride only is referred to. 

Applied to the skin, veratrum viride excites redness and heat, 
and, to the Schneiderian mucous membrane, it causes violent sneez- 
ing. It is a prompt and efficient emetic, but its operation is 
accompanied with intense nausea and depression, and the vomiting is 
often violent and persistent. The contents of the stomach are at first 
evacuated, and afterward of the gall-bladder, sc that it has been sup- 
posed to possess the power to increase the secretion of bile. It does 
not generally purge, but occasionally profuse watery evacuations have 
been produced by it, and rarely severe hypercatharsis. Its alkaloids 
enter the blood with facility. The power which veratrum viride lias to 
affect the cardiac movements and the vascular tonus is its most charac- 
teristic property. It lowers, in a remarkable manner, the number and 



VERATRUM VIRIDE. 501 

force of the cardiac pulsations. The pulse may be reduced to fifty, 
forty, or even thirty-five per minute, and its force correspondingly 
diminished. According to Linon, the arterial tension is raised, as 
shown by the sphygmograph. By very careful administration, this 
reduction in the pulse-rate may sometimes be accomplished without 
inducing nausea and vomiting, but usually vomiting cannot be pre- 
vented when the remedy is pushed to this extent. When the pulse is 
reduced very decidedly, the patient being in the recumbent posture, a 
change to the erect position at once alters its character, and it becomes 
extremely rapid, thready, and feeble. 

Very great depression of the powers of life is produced by large 
doses. The action of the heart becomes exceedingly weak, the pulse 
almost indistinguishable, the vomiting and retching extreme, the sur- 
face of the body cold and covered with a cold sweat, the temperature 
reduced. There are also produced faintness, dimness of sight, dilata- 
tion of the pupils, giddiness, great muscular weakness, shallow and 
slow respiration ; sometimes somnolence, coma, and insensibility," with 
stertorous breathing. Notwithstanding the very formidable symp- 
toms produced by large doses, fatal results have been extremely rare. 
An ounce of the tincture has been swallowed without causing death 
(Norwood). The prompt emesis which it produces is probably the ex- 
planation of its lethal inactivity ; for, in the act of vomiting, the medi- 
cine is ejected with the first matter from the stomach. Suspension of 
the medicine and free stimulation quickly remove the most alarming 
symptoms of depression. 

The experimental investigations into the actions of jervia and vera- 
troidia, made by Wood, Peugnet, and others, have shown that the phys- 
iological actions of veratrum viride are the sum of the actions of the 
alkaloids. The nauseating and emetic qualities of the drug are due, 
chiefly, to veratroidia, and to a slight extent to the resin. Both alka- 
loids depress the functions of the spinal cord, and destroy its reflex 
activity ; but they do not impair the excitability of the nerves, nor the 
contractility of muscles. Veratroidia, according to Wood, first stimu- 
lates the inhibitor}-- cardiac nerves to an extraordinary extent, and after- 
ward paralyzes them ; but the evidence which he adduces in favor of 
the singular statements on this point are far from satisfactory. Both 
alkaloids lower the blood-pressure, by diminution of vaso-motor tonus, 
and paralyze the cardiac muscle, and probably also its contained gan- 
glia. They cause death by asphyxia — by paralysis of the muscles of 
respiration. The cerebral effects which have been noted in man, and 
the convulsions in animals, are doubtless due to the' accumulation of 
carbonic acid in the blood. 

Therapy. — The best preparation for administration is the tincture. 
As the therapeutic properties of V. viride depend, chiefly, on the jer- 
via, an attempt may be made in the future to supply this alkaloid in 



502 MOTOR DEPRESSANTS. 

sufficient quantity for administration ; but, at present, the processes in- 
volved in its preparation are too intricate and expensive. As the effect 
of V. viride quickly reaches its maximum, if it be desired to maintain 
the pulse-rate at a constant level, the doses must not be at a longer in- 
terval than two hours. The effect must be maintained by increasing 
doses, if necessary, and the recumbent posture must be rigidly enforced. 

The emetic property of veratrum viride is never applied in practice: 
too much depression is produced by it. The chief use of this agent is 
to depress the action of the heart and to lower the vaso-motor tonus. 
In simple hypertrophy of the heart, without valvular lesion, it dimin- 
ishes the over-action and thus gives relief to the most distressing symp- 
tom. The irritable heart, so frequently found associated with and 
dependent on the excessive use of tobacco, on mental excitement and 
irascibility of disposition, and on overstrain, is relieved by this rem- 
edy, provided no valvular lesions coexist. The hypertropJiy of the 
cardiac muscle, and the abnormal arterial tension, which accompany 
the chronic form of albuminuria, are alleviated by veratrum viride. 
Moderate doses of the tincture (five drops ter die) usually suffice in these 
cases. When there are valvular lesions, and when the cardiac muscle 
is enfeebled from any cause, this agent is inadmissible. 

Excellent results are sometimes obtained in aneurism by the use of 
veratrum viride. In the various surgical expedients for the cure of 
aneurism (forced flexion, compression, ligation), this remedy, used to 
depress the circulation, renders an important service, by lessening the 
force with which the blood is propelled, and the number of the cardiac 
contractions. In this way, coagulation of the blood in the aneurismal 
sac is greatly favored. In the case of large internal aneurisms — of the 
innominata, aorta, etc. — veratrum viride is a powerful adjunct to rest 
and other means of treatment. Some precautions are necessary, how- 
ever, in the administration of this remedy. As the utmost slowing of 
the circulation consistent with safety may be required, a sufficient quan- 
tity of the tincture must be administered to accomplish this object, and 
the effect produced is the only measure of the amount to be given. The 
result must be accomplished, if possible, without causing vomiting. 
The patient should, therefore, remain absolutely in the recumbent post- 
ure, and a little opium should be prescribed with the veratrum viride. 
Active haemorrhage, occurring in the plethoric, is sometimes stopped by 
full medicinal doses of this drug. 

There can be no doubt that veratrum viride renders an important 
service in acute parenchymatous congestion — of the brain, lungs, liver, 
and other organs. Its utility ceases when exudations have taken place: 
its action is confined to the influence which it has in diminishing the 
blood-supply to the affected organs. The changes produced by inflam- 
mation are in no wise affected by veratrum viride. Much that is extrav- 
agant has been written in regard to its curative influence in pncumo- 



VERATRUM VIRIDE. 503 

nia, but we need not be surprised at this, when we reflect that our 
knowledge of the natural history of this disease is only of recent origin. 
Those who knew nothing of the period of crisis of pneumonia naturally 
attributed the defervescence of temperature to the effect of the remedy. 
It is not to be denied that in the very incipiency of pneumonia, before 
fibrinous exudation has taken place, veratrum viride, by lessening the 
amount of blood circulating in the lungs, may render an important ser- 
vice, but when hepatization occurs its good effects cease. The same 
observations are true of other parenchymatous inflammations, and 
equally so of serous inflammations. 

Veratrum viride has been much extolled as a remedy for reducing 
the pulse-rate and the temperature in typhoid and other fevers (Nor- 
wood). It is true, these effects may be procured by it, but that any 
influence is exerted in this way, over the course and duration of a fever, 
seems highly improbable. The chief dangers in fever being the occur- 
rence of cerebral or cardiac paralysis due to the persistent elevation of 
the temperature, it is unwise to use a powerful cardiac depressant, 
although it has the power to lower the temperature somewhat. There 
is, however, a condition of things arising in the course of fevers — viz., 
delirium ferox — in which, when dependent on arterial excitement, much 
good may be accomplished by the use of veratrum viride. 

The excitement of acute mania, of maniacal delirium, and other 
forms of mental disorder in which a condition of cerebral hyperemia 
may be supposed to exist, is successfully combated by veratrum viride. 
In a private communication, Dr. Sullivan of San Francisco informs me 
that this agent ( 3 ss of the Fluid Extract every fifteen minutes until 
nausea or vomiting ensues) is " invaluable in puerperal convulsions." 

Veratria is used only externally, and for the relief of neuralgia, 
headache, myalgia, etc. The officinal unguentum veratrice is the form 
in which it is employed — a small quantity being rubbed in over the seat 
of pain. 

Authorities referred to : 

Briesemann, C. Mikroskopische Untersuchungen uber die Wirkung des Digitalhi, 
Veratrin u. Ergotin auf die Cirkulation, Rostock, 1869. 

Lixon, M. Gazette Medicate de Strasbourg. Bulletin General de Therapeutique, vol. 
Ixxvi., p. 94. 

Mitchell, Charles L. Transactions of American Pharmaceutical Association, vol. 
xxii., p. 397. The Active Principles of the Officinal Veratrums. 

Norwood, Dr. W. C. The Authorship and Therapeutical Powers of Veratrum Viridt 
more fully examined, Albany, 1868, p. 39. 

Oulmont, M. Bulletin General de Therapeutique, vol. lxxiv., p. 153. 

Ibid. Communication of paper by MSI. Zuber and Hirtz to Society of Therapeutics, 
Bulletin General, vol. Ixxvi., p. 468, et seq. 

Perot, Dr. S. R. Transactions of American Medical Association, 1864. 

Peugnet, Dr. Eugene. Tlie Medical Record, May, 1872. 

Squarey, Dr. Tlie Practitioner, 1S70, vol. i., p. 211. 

Wood, Dr. H. C. The American Journal of the Medical Sciences, January, 1870. 

United States Dispensatory, thirteenth edition. 



504 MOTOR DEPRESSANTS. 

Pulsatilla. — Pasque-flower. Pulsatille, Fr. ; ITilchenschelle, Ger. 
(Unofficinal.) 

Preparations. — There are no official preparations. The tincture 
is the form usually employed in medical practice, the dose of which 
varies from one minim to twenty minims. 

Composition. — The peculiar powers of the plant depend on the 
presence in it of an alkaloid — Anemonine, a camphor. Anemonine crys- 
tallizes in prisms — the regular rhombic system — and is hardly at all 
soluble in cold water and in alcohol (Husemann). Pulsatilla also con- 
tains a peculiar acid — anemonic acid. 

Antagonists and Incompatibles. — The caustic alkalies, tannic 
acid, and the metallic salts generally, are chemically incompatible. 
From the physiological standpoint, Pulsatilla is antagonized by the 
alcohols, by opium,' digitalis, etc. 

Synergists. — The effects of Pulsatilla are promoted by the para- 
lyzers, especially by the other members of the same family — notably, 
by aconite, cimicifuga, etc. 

Physiological Actions. — The local effects of pulsatilla (the fresh 
plant) are those of an irritant ; and, after prolonged contact, even caustic 
effects are produced. Applied to the tongue, it gives rise to tingling, 
burning, followed by numbness — effects very similar to those caused by 
aconite. On the intestinal mucous membrane it has very pronounced 
irritating effects. The active principles diffuse into the blood with 
facility. Depression of the heart's action, lowering of the arterial ten- 
sion, and declination of temperature, are caused by pulsatilla. It is a 
paralyzer of motility and sensibility, but, as respects the motor func- 
tions, it is not known whether it impairs the contractility of muscle or 
the irritability of nerve ; and, as respects sensation, it has not yet been 
determined whether the lessened sensibility is due to an influence 
which this remedy has on the spinal cord, on the nerve-trunks, or on 
the peripheral expansion — end-organs of the sensory system. Dilated 
pupils, hebetude of mind, stupor, coma, and convulsions, are cerebral 
symptoms which occur after a lethal dose has been administered. 
These cerebral effects may be due to a primary action of pulsatilla on 
the brain, or to the carbonic-acid poisoning, and the anaemia. When 
the action of the heart and the respiration are very feeble, carbonic 
acid accumulates in the blood, and an extreme degree of cerebral 
anaemia ensues. Coma, convulsions, and insensibility, are natural 
effects of these causes. Nothing is positively known as to the time 
and mode of elimination of anemonine, but it is probable that excretion 
takes place by the kidneys. 

The production of any given physiological effect will, of course, 
depend on the genuineness of the drug. The active principles are 
volatile, and often disappear in the process of desiccation. 

Therapy. — Owing to the irritating action of pulsatilla, it is not 



GRINDELIA. 505 

suited to the treatment of gastro-intestinal disorders, especially when 
a state of inflammation exists. Notwithstanding this local irritant 
effect, homceopathists employ it for the relief of dyspepsia, and the 
accompanying mental symptoms ; but, in coming to conclusions as to 
its curative value, they calmly ignore the natural history of these 
maladies. 

Pulsatilla is adapted to the treatment of acute inflammation of the 
nasal, faucial, laryngeal, and bronchial mucous membrane — acute 
catarrh. It is not proper in those cases when accompanied by gastro- 
intestinal disturbance. It is clearly useful in acute inflammation of 
the cerebral and spinal meninges. 

It is used by the homceopathists in the treatment of catarrhal oph- 
thalmia, by internal and local applications ; and they hold that it is 
very efficacious in certain diseases of the uterus, on which organ they 
suppose it to have a special or specific action. Sudden arrest of the 
menstrual flow, whether caused by moral emotion, or cold, may be re- 
lieved, and the effects prevented, by pulsatilla. As aconite is very 
useful under the same circumstances, it may be assumed that good 
results may be had by the administration of pulsatilla. 

Authorities referred to : 

Gubler, Prof. A. Codex Medicamentarius, p. 17. 
Hdsemann, Drs. Arc r.\n Tiieod. Die Pflanzcnstoffe, p. 795. 
Phillips, Dr. Charles D. F. Materia Medica and Therapeutics, p. 17. 

Glilldelia. — The leaves, stems, and flowers, of grindelia robusta. 

Composition. — An alkaloid with basic properties has been isolated 
(Rademaker), but its chemical relations have not been fully made out. 
The plant contains also a volatile oil, and a resin, to which its physio- 
logical activity is doubtless in part due. 

Preparations. — Fluid extract. Dose, m. x — 3 j. 

Antagonists and Incompatibles. — Water precipitates the oleo- 
resin. The mineral salts and caustic alkalies are chemically incom- 
patible. Opium, the cerebral stimulants, alcohol, strychnia, picrotoxine, 
etc., are opposed as respects the physiological actions. 

Synergists. — All motor depressants increase the actions of grin- 
delia. 

Physiological Actions. — The taste of grindelia is rather pungent, 
even acrid, and in the stomach it excites a sensation of warmth. The 
local stimulant effect is such that it promotes the appetite and diges- 
tion ; but, if too long continued, or in too great quantity, it excites 
gastric uneasiness. Grindelia slows, somewhat, the heart and respira- 
tory movements. When administered in sufficient quantity, decided 
cerebral effects are produced. It dilates the pupil and induces sleep. 
During this condition of hypnotism, the general cutaneous sensibility 
is much reduced, and reflex movements become sluggish. Motility is 



50G MOTOR DEPRESSANTS. 

also affected, the paresis beginning in the hind extremities. Its toxic 
powers are by no means great, two drachms of the fluid extract being 
required to induce sleep in small rabbits. It affects other warm-blooded 
animals, and also frogs, in the same way. When death ensues, it is 
from paralysis of the muscles of respiration. Elimination takes place 
by the pulmonary mucous membrane, and chiefly by the kidneys. 

Therapy. — The most important uses of grindelia, thus far devel- 
oped, are in the treatment of the respiratory neuroses. Its utility in 
the treatment of asthma, especially the so-called spasmodic asthma, is 
certainly great ; few cases fail to be relieved at once. Beside the 
stomach administration, it may be given in the form of fumes, accord- 
ing to the following plan : The plant is steeped in a saturated solution 
of nitre, dried, when it may be inflamed on an ordinary tin plate, the 
patient inhaling the fumes as they arise, or the fumes in the air of a 
small, closed apartment. This preparation may also be rolled into 
cigarettes, and smoked with or without the addition of tobacco, stra- 
monium, lobelia, etc. The fluid extract of grindelia may be incor- 
porated with other asthmatic remedies, in an extemporaneous prescrip- 
tion. For example : Ext. grindeliae fluid., § ss ; ext. lobelias, fl. 3 ij ; 
ext. belladonnse, fl. 3 j ; potassii iodidi, 3 iij ; glycerinae, 3 iij. M. Sig. 
A tablespoonful, as necessary. 

Cough by imitation and habit, whooping-couyh, and the spasmodic 
difficulty of breathing which accompanies various pulmonary and car- 
diac diseases, hay-asthma, etc., are helped by grindelia^ It is also an 
effective remedy for bronchitis, after the subsidence of acute symptoms ; 
for chronic bronchitis and bronchorrhcea, and for the bronchitis of 
emphysema. 

Besides the above diseases for which grindelia has been used with 
success, it will prove advantageous in chronic pyelitis, chronic cystitis, 
etc. In these diseases local application of the oleo-resin takes place 
all along the urinary tract. 

Authorities referred to : 

Crowe, Dr. John E. Louisville 3/cdical News, April, 1876. 
Fiske, Dr. H. M. The Pacific Medical and Surgical Journal. 
Rademaker, Dr. C. J. Louisville Medical News. 



Phytolacca. — Phytolacca; bacca. — The fruit of phytolacca decandra 
— poke-berries. 

Phytolacca; radix. — The root of phytolacca decandra — poke-root. 

Preparations. — Extractum Phytolacca; Fluidum. — Fluid extract 
of phytolacca. Dose, m. v — 3 j- 

Tinctura Phytolacca;. — Tincture of phj^tolacca. Dose, m. x — 3 j- 

Composition. — An active principle has not been isolated. 



PHYTOLACCA. 507 

Antagonists and Incompatible*. — Alcohol, ether, strychnia, opium, 
digitalis, etc., oppose the action of phytolaeca. 

SYNERGISTS. — All depressing- agents, the paralyzers, and emetics, 
contribute to the effects of phytolaeca. 

Physiological Actions. — Poke is nauseant and emetic, and these 
effects occur, whatever may be the mode of administration. The emesis 
does not occur at once ; there is a slowly-accumulating anguish; vomit- 
ing does not result for an hour, and the vomiting is accompanied with 
great depression. 

Phytolacca lowers the rate of cardiac movement and the respiration, 
but does not alter the rhythm. It is a paralyzer, the loss of power 
occurring first in the hind extremities. The impairment of motility is 
not due to an action of this agent on the motor nerve or on the muscle 
— for the irritability of the nerve and the contractility of muscle remain 
unaffected when a lethal dose of phj'tolacca has been given. The action 
is on the spinal cord, chiefly on the medulla. In rabbits, violent trem- 
bling occurs, and convulsions, partly tonic, partly clonic, are produced. 
Death ensues from paralysis of respiration ; for in frogs, when all signs 
of life have ceased, the heart is found to be in action, on opening the 
chest. In cases of accidental poisoning, convulsions of a tetanic char- 
acter have been observed. Elimination takes place chiefly by the 
kidneys. 

Therapy. — Poke has been proposed as an emetic, but the slowness 
of the action, and the great depression of the powers of life which it 
causes, have prevented, and will ever prevent, its employment for this 
purpose. 

Alterative powers have been ascribed to it, and cases supposed to 
be malignant have been cured ; but these results were probably in- 
stances of the post rather than the propter hoc. Ulcers, cutaneous dis- 
eases, and ophthalmia, are maladies which have been reported cured. 
The evidence is strong that phytolaeca does possess considerable power 
to promote- the healing of varicose and other ulcers of the leg (Tidd). 
A soft extract is spread on muslin, and kept applied to the surface of 
the ulcer. Obstinate eczema has been cured in the same way. The 
pain and inflammation of burns may be assuaged by the same applica- 
tion, and the healing greatly facilitated. How far the effect is merely 
mechanical does not appear. 

It has long been known that phytolaeca is a serviceable remedy in 
chronic rheumatism. But the therapeutical application of this remedy 
most deserving of consideration is the treatment of inflamed breasts. 
There seems to be no reason to doubt that phytolaeca possesses the 
remarkable property of arresting an inflammation of the mamma, and 
preventing suppuration. For this purpose the fluid extract may be 
given internally, and the solid extract spread on a cloth and kept 
applied to the breast, which is the seat of the inflammation. The pos- 



508 MOTOR DEPRESSANTS. 

session of this property to prevent suppuration in the breast implies 
the existence of the same property in threatened suppuration in other 
glandular organs. As the fact is entirely empirical, and rests on no 
physiological action of the drug, it can only be determined by further 
trials whether it will check suppuration elsewhere. 

Authorities referred to : 

Biggers, Dr. G. W. The American Journal of the Medical Sciences, to!. Ixv., p. 275. 
Dutcher, Dr. A. P. The Cincinnati Lancet and Observer, June, 1859. 
Tidd, Dr. C. H. The Clinic, vol. v., p. 253. 
United States Dispensatory, fourteenth edition. 

Ailanthus — The bark of a. glandulosa, a well-known and abundant 
shade-tree. 

Preparations. — Fluid extract. Dose, m. x to 3 j- Bark, gr. x — 

3j- 

Composition. — The most important constituent is the oleo-resin. 
It contains, also, a volatile oil, which is extremely diffusible and pow- 
erful, and a bitter principle. 

Actions and Uses. — The taste is better and somewhat acrid. It is 
strongly nauseant, and the nausea is accompanied with weakness, ver- 
tigo, and cold sweating. It possesses decided purgative property, the 
stools being large and watery. It has considerable power as a vermi- 
fuge, and is effective when employed against tasnia. The action of the 
heart is at first increased, but is subsequently slowed, the pulse becom- 
ing small and weak. Respiration is similarly affected, and death en- 
sues in animals by paralysis of the muscles of respiration. 

On the brain and nervous system ailanthus acts as a paralyzer, the 
loss of power beginning in the hind extremities. The paralyzing ac- 
tion seems to depend on the volatile oil, while the purgative and an- 
thelmintic effects are possessed by the oleo-resin. 

Therapy. — The most important application of ailanthus is in the 
treatment of tape-worm. For this purpose the oleo-resin, or, better, a 
decoction of the fresh bark ( 3 j — § iv.), may be used. The oleo-resin 
has the advantage in being a permanent preparation, whereas the bark 
loses its strength in the process of drying. 

Muscarine or Muscaria, the alkaloid of amanita muscaria, the fly- 
fungus. 

Properties. — Muscarine is an alkaloid with strong basic properties, 
and combines with acids to form salts. It has the consistence of sirup, 
is without odor, free from taste, and is readily soluble in water and in 
alcohol, but is insoluble in ether and in chloroform. Besides being ob- 
tained from the fungus, it has been constructed synthetically, the 
product having the same actions it is alleged, but this statement seems 



MUSCARINE. 509 

doubtful, especially in view of the rather negative results reached by 
Ringer, with a specimen furnished by Merck, of Darmstadt. 

As muscarine is but slightly irritating to the tissues, it may be used 
subcutaneously. The dose ranges from one-eighth of a grain to two 
grains. According to Ringer, one-third of a grain is the minimum 
quantity to produce symptoms in men, administered hypodermatic-ally, 
but in this statement he referred to Merck's alkaloid prepared synthet- 
ically. 

Antagonists. — The actions of muscarine are antagonized by atropine 
(Schmiedeberg and Koppe), by digitalin (Bohm), and by eserine (Pre- 
vost). By atropine it is antagonized at all points. When the heart is 
arrested by muscarine, it possesses the capability of again renewing its 
action under the influence of a large number of agents, but atropine 
possesses this property in the highest degree (Alison). Muscarine ar- 
rests the heart in diastole by stimulating the intracardiac inhibition ap- 
paratus — atropia paralyzes this apparatus (Prevost) ; muscarine causes 
intense dyspnoea by inducing strong contraction of the pulmonary 
arteries — atropine relaxes this spasm, unloads the right cavities of the 
heart, and respiration is resumed ; muscarine lowers, atropine raises the 
blood-pressure ; muscarine tetanizes the muscular layer of the intestine 
— atropine relaxes the spasm ; muscarine increases the secretions of liver, 
pancreas, and intestinal mucous membrane — atropine arrests these secre^ 
tions ; muscarine arrests the renal secretion — atropine restores it ; mus- 
carine causes sweating, salivation, and lachrymation — atropine dries 
them all ; muscarine contracts the pupil — atropine dilates the pupil. 
For the quantity producing a given physiological effect, the power of 
the two agents is very unequal, atropine being much stronger. An 
atropinized eye dilated to a certain point will not be contracted by 
the quantity of muscarine sufficient when unopposed to induce a marked 
degree of myosis ; but a much larger quantity may overcome the atro- 
pine. The same fact is true throughout the whole range of their 
antagonistic action. 

In frogs j>oisoned by digitaline, the cardiac movements recommence 
and are maintained for hours by the application of a solution of mus- 
caria. The same fact is true of tobacco and physostigma : the heart 
arrested by these agents recommences movements when muscarine is 
applied, and vice versa. 

Synergists. — The motor depressants synergize some of the actions 
of muscarine. A close correspondence exists between pilocarpine and 
muscarine. They both cause nausea, diarrhoea, muscarine at first quick- 
ens then slows, and pilocarpine quickens the pulse ; they both flush the 
face and produce free perspiration and salivation ; they both cause 
frontal headache ; both contract the pupil ; and both diminish the 
urinary secretion. They differ in some respects, but chiefly in the ex- 
tent of their action, or quantitatively. Pilocarpine causes more perspi- 



510 MOTOR DEPRESSANTS. 

ration and salivation ; muscarine produces decidedly more active intes- 
tinal movements. Pilocarpine diminishes the urinary secretion, but 
muscarine may arrest it entirely. Pilocarpine slightly contracts the 
pupil ; muscarine contracts the pupil more decidedly, but when applied 
to the eye directly, dilates the pupil. Pilocarpine always quickens the 
pulse, muscarine slows the pulse. 

Physiological Actions. — The salivary secretion in a large pro- 
portion of subjects is much increased. A feeling of constriction of the 
neck, nausea, and vomiting, and more or less abdominal pain, are pro- 
duced by it, whether administered by the stomach or subcutaneously 
(Brunton). The pancreatic and biliary secretions are notably increased 
after the injection of some milligrammes into a vein (Prevost). This 
increase of these secretions took place as well between as during di- 
gestion. The intestinal mucus is also greater in quantity than normal, 
and it may be streaked with blood (Schiff). The intestines are thrown 
into active contractions, tetanized, rather than merely stimulated into 
more frequent vermicular movements. Under ordinary medicinal doses 
in man, the bowels are relaxed and the character of the evacuations 
altered, doubtless, because of the much greater quantity of the biliary 
and pancreatic secretions poured out. The increased movement of the 
intestines is accompanied by considerable colic-like pain. 

Muscarine enters the blood promptly, whether introduced through 
the stomach, or subcutaneously. It is a cardiac poison. A very mi- 
nute quantity — a mere trace — applied to the frog's heart, ai-rests its 
movements. As Schmiedeberg and Koppe first demonstrated, it ar- 
rests the heart in the diastole, and does not impair the irritability of 
the heart-muscle, for, on irritation of the heart by mechanical, chemi- 
cal, or electrical means, it again contracts. If the dose is short of 
lethal, the heart is merely slowed, the number of pulsations being re- 
duced ten, twenty, or even forty beats per minute. Section of the 
vagi does not affect this result. The action is due to stimulation of 
the intracardiac inhibitory apparatus. By Alison it is referred to over- 
excitation of the cardiac terminals of the vagus, and coincident dimi- 
nution in the activity of the sympathetic fibres. "When the effects of 
muscarine are manifested by a diminution of the pulse-rate, the blood- 
pressure begins to decline. At first the vessels contract, but this is 
soon succeeded by dilatation (Bogosslowsky). With the slowing of 
the heart and dilatation of the vessels, the blood accumulates in the 
periphery, and the blood-pressure is consequently reduced one-half. 

Disturbances of respiration occur with the other defined symp- 
toms. The breathing grows more labored with the increasing effects 
of the agent, and presently an intense dyspnoea supervenes (Schmiede- 
berg). The mechanism of the labored respiration is obvious enough. 
Such a strong contraction of the pulmonary vessels ensues as to greatly 
diminish the quantity of blood circulating in the lungs, with the re- 



MUSCARINE. 511 

suit of over-distention of the right cavities of the heart. Hence it 
follows that the state of the blood is impaired by the lack of oxygen 
and the retention of carbonic acid, and to these factors must be attrib- 
uted in part the cyanosis and asphyxia. These modifications of the 
respiration occur after preliminary section of the vagi. The almost 
arrested oxygenation of the blood, the languid circulation, and the 
profuse perspiration, are the factors which cause a lowering of the 
temperature. By Schmiedeberg and Koppe there are recognized three 
conditions of the body-heat : 1. A slight elevation, which is by no 
means constant, and very transient, coming on in about two hours 
after the dose — a small one — has been taken ; 2. A depression of one 
or two degrees, succeeded presently by the normal temperature, pro- 
duced by a full medicinal dose ; and, 3. A very pronounced lowering 
of the temperature from a fatal dose. 

By the internal administration of muscarine the pupil contracts, and 
singulai'ly enough, by direct application, dilates. There are other ex- 
amples of this paradox. Vision is disturbed by alteration of the 
accommodation apparatus by spasm. The myosis depends on stimu- 
lation of the circular fibres of the iris or of the third nerve, and not 
on paralysis of the radiating fibres, or of the sympathetic filaments. 

Muscarine produces abundant perspiration, and, indeed, stimulates 
this function only less powerfully than pilocarpine. In most cases 
the saliva is correspondingly increased. The two functions do not 
always act together with the maximum energy, and one may be pow- 
erfully affected, while the other is quiescent. Lachrymation is nearly 
constant, and the nasal mucus is more abundant than in the normal 
state. Thus, while all other secretions and excretions are increased 
by muscarine, it is remarkable that the urine should be decidedly less- 
ened in amount, even suppressed. In eight experiments made with 
great care, Prevost found that the injection of muscai-ine into a vein 
diminished the urinary secretion, and, indeed, almost stopped it when 
the dose was large. The elimination of muscarine takes place by the 
kidneys. The best evidence that it is excreted unchanged is the 
physiological action of the ivrine. The urinary secretion of an animal 
poisoned by muscarine will poison another animal to whom it is admin- 
istered, and its powers are transmitted with little diminution through 
several. 

Therapy. — The applications of muscarine to the treatment of dis- 
ease are yet in their infancy. The physiological effects indicate the 
direction of the remedial applications. As muscarine stimulates so 
powerfully the muscular fibre of the intestine, and the secretions of 
the pancreas, liver, and intestinal mucous membrane, it ought to be 
very serviceable in cases of constipation with torpor of the organs 
concerned in digestion. When constipation is due to paresis of the 
muscular layer of the bowel and to deficient secretion, this remedy 



512 MOTOR DEPRESSANTS. 

will probably relieve it. In the treatment of intestinal torpor and 
deficient secretion, muscaria may be combined with other remedies, as 
atropia and strychnia, which act on the organs concerned, or with 
cathartics and cholagogues : $. Muscaria?, gr. iv ; ext. belladonna?, 
cxt. nucis vomica?, aa gr. iij ; euonymin, 3 ss. M. ft. pil. no. xij. 
Sig. One pill morning and evening. "When the digestion of the starches 
and fats is imperfect, it is strongly indicated. In catarrh of the duode- 
num, and in catarrhal jaundice, it ought to be very efficient. In these 
maladies, the remedy should be administered frequently and in small 
doses: 1J.. Muscaria?, gr. j ; aqua?, % j. M. Sig. A teaspoonful every 
three hours. It is probable, also, that it will prove useful in recent 
hemorrhoids due to congestion of the portal circulation. It promises 
well as a remedy for the removal of inflammatory effusions and exuda- 
tions. It ought to afford prompt relief at the onset of a common 
cold, an acute bronchitis, hay-asthma, etc. As muscaria produces 
strong contraction of the pulmonary capillaries, it ought to be useful 
in pulmonary haimorrhage, in incipient congestion of the lungs, etc. 
Under such circumstances the combination with digitalis ought to be 
especially effective, for, while digitalis will aid the curative action on 
the pulmonary vessels, it will, at the same time, antagonize the cardiac 
depression caused by muscaria. It is contraindicated in affections 
of the air-passages when secretion is in excess. For the night-siveats 
of phthisis the fly-fungus has long been used, and is commended by 
Trousseau ; but it has not been as successful in the hands of Murreli 
as some other agents, although capable, sometimes, of very good 
results. Muscarine is of doubtful propriety, if not positively contrain- 
dicated, in renal affections characterized by deficiency in the excretion. 
On the other hand, it ought to be of signal service in diabetes insipidus 
and in saccharine diabetes. It has been used successfully to arrest the 
secretion of milk. 

Authorities referred to : 

Alison, Dr. BouchardaVs Annuaire de Therapeutiquc, etc., for 1S*T7, p. 47 ; also, 
Gaz. Med. de Paris, February 20, 1877. The Action of Atropine and Muscarine on the 
Heart. 

Bogosslowsky, Dr. Centralblatl fur die med. Wisscnschaften, No. 97, 1870. 

Brunton, T. Lauder. Journal of Anatomy and Physiology, 1876, p. 342. 

Harnack, Dr. Erich. Archiv fur expcrimentellc Pathol, und Pharmacol., Band iv., 
p. 168. Untersuchunycn ubcr Pflcgcnpilzalkaloide. 

Prevost, Dr. J. L. Bull. Gen. de Thirap., vol. xciii., p. 371. Note relative d VAn- 
tagonisme mutual de V Atropine et de la Muscarine. 

Ringer and Mosshead. Ringers Handbook of Therapeutics, eighth edition, Art. 
Muscarine. 

Schiff, Prof. Lo Sperimcntalc, abstracted in the London Medical Record, vol. iv., 
1876, p. 339. 

Schmiedeberg UND KoprE. Das Muscarin, das giftige Alkaloid des FliegcnpUzcs, etc. 
Leipsic, 1869. Vogel. 



OXYGEN. 513 



A GENTS II A VING TIIE PO WER TO ARREST SEPTIC 
PROCESSES AND TO DESTROY THE FERMENTS 
OR TIIE MINUTE ORGANISMS, ON THE PRES- 
ENCE OF WHICH THEIR ACTIVITY DEPENDS. 

ANTISEPTICS. 

Those remedies are entitled antiseptic which are employed to ar- 
rest fermentative processes. It is now generally admitted that every 
kind of fermentation is correlative of the growth and multiplication of 
a living organism. In various diseases, microzymes, vibrio, bacteria, 
either stand in a causative relation to the morbid process, or are neces- 
sary to its evolution and development. As an exemplification of the 
influence exerted by these minute organisms in diseased states, I may 
mention the bacteria of Oertel, which are formed in such immense num- 
bers, and attain to such wide diffusion in diphtheria, the protomycetes 
of Obermeier, which play so important a role in relapsing fever, and 
the specific bacteria (cacobacteria) found by Burdon-Sanderson in the 
exudation of septic inflammation of the peritonaeum. Disease-germs, 
which may not exist in definitely-organized forms, are, at least, consti- 
tuted of living matter, having properties apparently similar to those 
ferments with which chemistry has made us acquainted. 

The remedies of this group — antiseptica — have the power, when 
brought into contact with the minute organisms or disease-germs men- 
tioned above, to destroy their vitality, and to arrest the fermentation 
process, or zymosis, which they either initiate or promote. There is a 
distinct relation between the antiseptic and antipyretic properties of 
various members of this group, and they have the power to depress 
temperature in the same ratio that they are active in destroying disease 
ferments and germs. Some of these remedies, e. g., quinia, sulphurous 
acid, the sulphites, etc., have already been discussed in Part II. Un- 
der this head there remain for consideration several important agents 
whose applications are also topical. 

Oxygenium. — Oxygen, Ozone. Oxygbie, Fr. ; Sanerstoff, Ger. A 
permanent, elastic gas, inodorous, without taste, incombustible, but 
uniting with bodies in a state of combustion. It is very slightly solu- 
ble in water at the ordinary temperature and pressure. 

The quantity of oxygen which may be inhaled, in the ordinary 
medicinal applications of this gas, ranges from one to five gallons. 
The simplest apparatus will suffice, but an elastic bag, with a suitable 
mouth-piece, is usually employed for this purpose. 

Physiological Actions. — If the important role which oxygen plays 
in the economy of Nature furnished a measure of its powers when ad- 
34 



514 ' ANTISEPTICS. 

ministered as a remedy, it would be a most important therapeutic agent. 
When inhaled in the pure state (not as air), it produces 'singularly little 
constitutional disturbance. A sensation of warmth in the larynx, tra- 
chea, and bronchi, is first experienced; the pulse, as a rule, somewhat 
increases, though it may be lessened in frequency; a sense of mental 
exhilaration and a disposition to greater bodily activity are produced ; 
the appetite becomes keener ; but no constant influence on the excre- 
tions has been noted (Demarquay). Experiments on animals have de- 
monstrated that the inhalation of oxygen per se does not have an injuri- 
ous effect on animal life (A. H. Smith). 

Therapy. — Oxygen is indicated and has been used with success in 
diseases of the respiratory organs, characterized by dyspnoea, due to 
causes interfering with the oxygenation of the blood, in emphysema, 
asthma, croup, asphyxia, chloroform narcosis, asphyxia from toxic 
gases, etc. In these cases oxygen acts in a manner which is perfectly 
obvious : the labor of breathing and the damage to the respiratory 
centre are lessened by the addition to the blood of oxygen in larger quan- 
tity than is supplied by the air. In these cases, pure oxygen, or a mixt- 
ure of one part of the gas to two or three of air, may be employed. 
The more extreme the dyspnoea, the greater the necessity for undi- 
luted oxygen. 

Oxygen is also indicated, and has been successfully employed, in cer- 
tain diseases characterized by insufficient oxidation: cJilorosis, ancemia, 
leucocythemia, diabetes, albuminuria, etc. In such cases the internal 
administration of chalybeate medicines, or mineral waters, should ac- 
company the inhalations of oxygen. Pure oxygen is not necessary ; an 
admixture with three parts of air will suffice, and the inhalation should 
be made morning and evening. 

The evidence is satisfactory that oxygen-inhalations produce good 
results in some cases of phthisis. Those cases appear to be most bene- 
fited in which emaciation, dyspeptic symptoms, etc., have occurred, 
without marked change in the condition of the lungs. When hectic 
fever comes on, and excavations have occurred, the utility of oxygen 
has ended, except as a palliative of dyspnoea. 

Authorities referred to : . 

Andrews, Dr. J. B. The Detroit Review of Medicine and Surgery, December, 1871, 
p. 571. 

Birch, Dr. The T/ierapeutic Action of Oxygen, London, 19,5*1. The British Medical 
Journal, December 24 and 31, 1859. 

Bricheteau, Dr. F. Bulletin Generate de Therapeutique, vol. lxx., p. 162. 

Demarquay, Dr. JEssai de Pncumatologie Medicate, etc., Paris, 1866. 

Hacexey, Dr. C. E. JVeio York Medical Journal, vol. ix., p. 597. 

Mackey, Edward. The Practitioner, vol. ii., p. 278. 

Smith, De. A. H. Kew York Medical Journal, vol. xi., p. 152. 

Waldenburo, Dr. L. Die locale Behandlung der Kranklieiten der Athmungsorganf^ 
Berlin, 1872, p. 690, it seq. 



CHLORINE. 515 

Chlorinium. — Chlorine. Chlore, Fr. ; Chlor, Ger. 

Properties. — Chlorine is a, greenish-colored gas, of a persistent, 
penetrating, suffocating, and characteristic odor. It is soluble in water 
in the proportion of two volumes (of gas) to one. 

Aqua Chlorinii. — Chlorine-water. "Is a greenish-yellow liquid, 
possessing the suffocating odor of chlorine." 

Liquor Sodcv Chlorinatoz. — Solution of chlorinated soda. " A trans- 
parent liquid, of a greenish-yellow color, having a slight odor of chlo- 
rine, and a sharp, saline taste." 

Calx Chlor inata. — Chlorinated lime. Chloride of lime. " A gray- 
ish-white substance, in powder or friable lumps, dry or but slightly 
moist, and wholly dissolved by dilute muriatic acid, with the escape of 
chlorine." 

Physiological Actions. — Chlorine as a gas, or in solution in water, 
is an active irritant. Applied to the skin for some minutes it causes 
heat and burning, increased diaphoresis, and, if the contact be sufficient- 
ly prolonged, vesication. Inhaled in very small quantity, largely di- 
luted with air, this gas induces a sensation of warmth in the chest, and 
increases the bronchial mucus. In considerable quautity it is a violent 
irritant, excites spasm of the glottis, and sets up active inflammation of 
the larynx, bronchi, and lungs. 

Chlorine is without action when moisture is not present. Water is 
decomposed by it, chlorhydric acid is formed, and oxygen set free as 
active oxygen or ozone. The antiseptic and antiferment properties 
of chlorine are, therefore, due to the oxidizing powers of the liberated 
ozone. The sulphur and phosphorus compounds with hydrogen are de- 
composed by chlorine. When this gas is brought into contact with sul- 
phuretted hydrogen, chlorhydric acid is formed and sulphur is precipi- 
tated. On these chemical facts rest the deodorant and disinfectant 
powers of chlorine. 

Therapy. — Chlorine gas will arrest putrefactive decomposition of 
animal matters, and may, therefore, be employed as a preservative of 
anatomical preparations. As a deodorant and disinfectant it mav be 
used to destroy foul effluvia and disease-germs. It is irrespirable in 
sufficient quantity to affect disease-germs in the living subject, and it 
destroys the colors and even texture of fabrics, so that it is rarely used 
for disinfection of the person, or of the clothing of patients. 

Chlorine-water, chlorinated soda, and solutions of chlorinated lime, 
are employed locally in scarlet fever, diphtheria, aphtha?, and gangrene 
of the mouth and fauces. Their chief utility consists in removing fe- 
tor, but they probably, also, exert a toxic influence on disease-germs. 
r$. Aquas chlorinii, § ss ; aquse destil., 3 iijss ; syrupi simpl., § ss. M. 
Sig. As a gargle, or lotion for the mouth. IjL Calc. chlorinat., 3ss; 
mucilaginis, 3 ss ; aquas destil., 3 iijss. M. Sig. Lotion. To correct 
fetor of the breath, the following formula may be used: I£. Calc. chic- 



516 ANTISEPTICS. 

rinat., 3 iij ; aquas destil., alcoholis, aa § ij ; ol. rosas, gtt. iv. M. Sig. 
A teaspoonful to a tumblerful of water. 

Chlorine-water was formerly much employed in scarlet fever, typhoid, 
typhus, etc. Its use in these affections was predicated on its presumed 
power to arrest the zymosis of the morbid ferments. It need hardly be 
stated that such notions are no longer entertained. 

These chlorine preparations are unquestionably serviceable as deter- 
gent, deodorant, and antiseptic applications to sloughing and gangre- 
nous wounds. A solution of chlorinated soda is employed to prevent 
infection by animal poisons, the bite of serpents and insects, and the 
syphilitic virus. 

Formerly chlorine-water and chlorinated soda were used in chronic 
hepatic affections, but there is no evidence that they are serviceable. 

The toxic effects of chlorine gas may be prevented by ammoniacal 
gas (ammonium chloride). Albumen is the most suitable and conven- 
ient antidote to 'the chlorine preparations taken into the stomach. It 
should be given freely in the form of milk, eggs, flour, etc. 

Brominium. — Bromine. JBrome, Fr. ; Brom, Ger. " A dark-red 
liquid, having a strong, disagreeable odor. It is sparingly soluble in 
water, more soluble in alcohol, and still more so in ether." 

Physiological Actions. — The actions of bromine, considered from 
the chemical point of view, are similar to those of chlorine ; it decom- 
poses hydrogen compounds, forming bromhydric acid, and precipitating 
or separating the element associated with hydrogen. It is therefore a 
deodorant and antiseptic. The vapor of bromine is intensely irritant 
to the air-passages. It combines with the water and sets free ozone, 
which energetically attacks the mucous membrane. In sufficient quan- 
tity, laryngitis, bronchitis, and pneumonia, will be produced by the 
inhalation of its vapor. Applied in the liquid form, and undiluted, 
bromine acts as an energetic and very painful escharotic. A brownish 
slough is formed, which is afterward slowly detached. Internally, by 
the stomach, bromine acts as a corrosive poison, producing violent gas- 
tritis, and the phenomena of depression and collapse, which attend the 
action of corrosive poisons in general. 

Theeapt. — The vapor of bromine is an efficient remedy in acute 
coryza and hay-asthma. R. Brominii, 3ss; alcoholis, 3 iv. M. Sig. 
For inhalation. A small quantity of this solution may be placed in a 
wide-mouthed vial, and vaporized by the warmth of the hand. The 
vapor should be snuffed into the nose. It probably acts, as already ex 
plained, by setting free ozone. The pollen of plants, the presence of 
which gives rise to the symptoms of hay-asthma, is destroyed. The 
offensiveness of an ozcena may be removed by the same expedient. 
Chronic nasal catarrh may not unfrequently be greatly benefited by 
the vapor of bromine. 



CREOSOTE. 517 

The most important use of bromine is as an escbaietic. For the 
destruction of chancre, it is probably the best caustic. Hospital gan- 
grene, the experience of the rebellion demonstrated, was more certainly 
arrested by bromine than by any other escharotic. 

For the destruction of carcinoma uteri, this agent is preferred by 
some eminent gynaecologists. When used for these purposes pure bro- 
mine is applied, by means of a glass rod, thoroughly, to the diseased 
or sloughing or gangrenous surface. 

The objections to the use of bromine are its fetid odor, its volatility 
(boils at 117° Fahr.), and the pain which attends its escharotic action. 

Acidum Carbolicum. — Carbolic acid. Ph'enique acide, Fr. ; Carbol- 
.saure, Ger. " Is either in acicular crystals, or in crystalline masses ; white 
or colorless when perfectly pure, but, even when slightly impure, either 
reddish or becoming so on exposure ; deliquescent and readily assuming 
the liquid state in the presence of a little water, yet not dissolving; of 
a strong odor and taste, recalling those of creosote, but distinct ; fusible 
at from 93° to 106°, forming an oily liquid. It is soluble in from twenty 
to thirty-three parts of water, the purest being most soluble. Alcohol, 
ether, glycerine, and the essential oils, dissolve it freely. It combines 
with alkalies and other salifiable bases, but its compounds have still an 
alkaline reaction and are decomposed by the feeblest acids, even by 
carbonic acid." Dose, gr. ^ — gr. j. 

Acidum Carbolicum Impurum. — Impure carbolic acid. " Is either 
colorless or has a brown shade. It consists of carbolic and cresylic 
acids, in variable proportion, with impurities derived from coal-tar, 
which vary from ten to thirty per cent." 

Glyceritum Acidi Carbolici. — Glycerite of carbolic acid ( § i j car- 
bolic acid ; half a pint of glycerine). 

Aqua Acidi Carbolici. — Carbolic-acid water (glycerite of carbolic 
acid, 3x; water, one pint). Dose, a teaspoonful to a half-ounce. 

Unguentum Acidi Carbolici. — Ointment of carbolic acid ( 3 j — 1 j). 

Creosotum. — Creosote. " A colorless, oily, neuter liquid, having a 
strong-, characteristic odor, and an acrid, burning taste. Is sparingly 
soluble in water, but mixes in all proportions with alcohol and ether. 

" It is distinguished from carbolic acid, which it in some respects 
closely resembles, by not coagulating collodion when mixed with it, and 
by not imparting a blue color to a slip of pine-wood dipped first into an 
alkaline solution of creosote, and then, after drying, into muriatic acid." 

Aqua Creosoti. — Creosote-water ( 3 j — Oj). Dose, a teaspoonful to 
an ounce. 

Carbolic acid has largely superseded creosote as a remedy. 

Antagonists and Incohpatibles. — Combination with alkalies di- 
minishes, but does not entirely check, the physiological activity of car' 



518 ANTISEPTICS. 

bolic acid. Saccharate of lime, or lime, is probably the most efficient 
antagonist from tbe chemical point of view (Tb. Husemann). In cases 
of poisoning, this substance should be given freely. Tbe mucous mem- 
brane should be protected as far as possible by the administration 
of vegetable demulcents, but not by oils and glycerine, which favor 
absorption. I am indebted to Dr. A. C. Post, of New York, in a verbal 
communication, for the important fact that atropia is a physiological 
antagonist to the systemic symptoms induced by carbolic acid. He 
was induced to administer atropia in a case of poisoning by carbolic 
acid, on observing the minutely contracted pupils and the failing cir- 
culation. The result was successful. Similar success has attended the 
same practice in other cases. Experiments on animals have also de- 
monstrated the existence of this antagonism, which may now be regard- 
ed as an established fact. The rules for guidance in the administra- 
tion of atropia are the same as in other cases : a sufficient quantity of 
the antagonist is administered to maintain dilatation of the pupil and 
to overcome the depression of the circulation and respiration. Elimi- 
nation should also be promoted by the free use of diluents. 

Synergists. — All of the phenols, the antiseptics, the motor depres- 
sants, etc., increase the effects of carbolic acid. 

Physiological Actions. — Applied to the integument or to the 
mucous membrane, carbolic acid produces a burning sensation of 
short duration, and there is formed a whitish, superficial eschar, which 
subsequently becomes broAvnisb. The taste of carbolic acid is sweet- 
ish, cooling, and then pungent and hot. "When swallowed by accident 
or design, the mucous membrane appears as if brushed over with a 
strong solution of nitrate of silver, and becomes hard and dry, like 
leather. This appearance is observable about the lips, fauces, the 
oesophagus, the cardiac and pyloric extremities of the stomach, and 
the summits of the folds of the mucous membrane in the organ gen- 
erally. This change in the condition of the membrane is due to the 
power of carbolic acid to coagulate the albumen of the tissues. Vom- 
iting is not constant, even when toxic doses are swallowed, and the 
vomited matters smell of the poison. From medicinal doses, a cooling, 
rather grateful sedative effect is experienced in the stomach. It dif- 
fuses into the blood with great facility, from the stomach, from the 
external integument, and from wounded surfaces. Cases of poison- 
ing have resulted from application to a patch of psoriasis (Toel), to 
scabies (Hoppe-Seyler, Machin), to the uterine cavity, after the enu- 
cleation of a fibroid (Rheinstadter), to abscesses (Kohler, Wallace, 
White), to the rectum for the relief of ascarides (Pinkham, Z\Ii- 
chaelis), and to the integument and wounds, in cases of antiseptic 
surgery. Diffusion takes place with such rapidity, from these various 
sources, that formidable symptoms arise in a few minutes. Tbe amount 
necessary to produce distinct effects varies ; besides the difference due 



CARBOLIC ACID. 519 

to age, there are variations in susceptibility. A onc-per-cent. solution 
has caused serious symptoms injected into an abscess and into the 
rectum. Six drops of the pure acid have caused dangerous symptoms, 
and a teaspoonful has terminated fatally, but one case is reported in 
which this amount was recoA'ered from when taken by a child two 
and a half years old (Dessau). In Hoppe-Seyler's cases, while the two 
apprentices were rubbing each other's backs, both were seized suddenly 
with giddiness, vertigo, and tension of the head, and quickly passed 
into unconsciousness. These effects arc also experienced when the 
poison is taken into the stomach. The warnings of danger, which 
may be expected when the remedy is brought in contact with the 
tissues at any point, are, besides the local irritation, sudden vertigo, 
contracted pupils, pallor of the face, embarrassed respiration, and 
feeble circulation. When the dose is a fatal one, unconsciousness 
quickly supervenes, the breathing becomes stertorous, the surface 
grows cold, the action of the heart gets more and more feeble, and 
death finally occurs from failure of respiration. Convulsions occur in 
animals, but in man this symptom is wanting or at most fibrillary 
trembling, and some trismus of the jaws are present. 

The changes in the blood induced by carbolic acid have been much 
disputed. That it enters the blood as carbolic acid seems positively 
established, although having acid properties it may become a carbolate. 
The acid has been discovered in the blood by Hoppe-Seyler. That it 
appropriates oxygen and thus undergoes some change in the blood is 
highly probable. Husemann maintains that the blood in carbolic-acid 
poisoning is very much altered in character, becoming dark in color 
and coagulating with difficulty, but in the reports of various post-mor- 
tem examinations it is remarked that the blood was coagulated in the 
heart and great venous trunks. Outside of the body the blood is 
quickly changed on the addition of carbolic acid, but these changes do 
not correspond to those which occur within the body. The action of 
the heart is at first slowed, but toward the end it becomes rapid. The 
blood-pressure falls considerably below the normal, due, Hoppe-Seyler 
says, to vaso-motor paresis. The first slowing of the heart is caused 
by stimulation of the end-organs of the vagus, and is prevented by 
division of the trunk of the nerve. The subsequent rapid action is 
due to the removal of the inhibition from paralysis of the vagus. Res- 
piration is at first stimulated and the respiratory acts are more frequent, 
but they are also more shallow. Division of the pneumogastrics does 
not entirely prevent this stimulation, although it lessens the effect, 
whence it is concluded that carbolic acid also stimulates the respiratory 
centre in the medulla (Salkowsky). This conclusion is strengthened 
by the fact that, if the vagi are previously divided, the administration 
of carbolic acid will still increase the respiratory acts for a time, show- 
ing that the stimulation of respiration must be ejected by an action 



520 ANTISEPTICS. 

on the end-organs of the vagi in the lungs as well (Salkowsky). Low- 
ering of the temperature has heen constantly observed in the experi- 
ments on animals, and in the cases of poisoning in man. The surface 
of the body is cool, and more or less livid. There are several factors 
concerned, doubtless, in the reduction of temperature. The diminu- 
tion in the blood-pressure and the arrested oxidation are the chief. 
The power of carbolic acid to reduce the temperature of fever is also 
clear, but in this respect it is inferior to salicylic acid (Eisenstein). In 
cases of poisoning the reduction of temperature reaches several de- 
grees, but in the normal condition in man ordinary medicinal doses 
have but little effect in this direction. 

A more or less minutely-contracted pupil is a nearly-constant phe- 
nomenon in carbolic-acid poisoning. It can hardly be doubtful that 
this effect is due to paralysis of the radiating fibres, leaving the cir- 
cular fibres unopposed. Carbolic acid unquestionably acts on the 
cerebral lobes — on the centres of conscious impressions — and suspends 
their functions. Vertigo and singing in the ears occur, and then con- 
sciousness is lost, the reflexes are suspended, and complete muscular 
resolution comes on. In warm-blooded animals clonic convulsions are 
pi'oduced, succeeded by paralysis. By direct application, as Bill was 
the first to demonstrate, carbolic acid suspends the irritability of the 
sensory nerves. If a tract of the integument be painted over with 
pure carbolic acid, an incision may be made into the part without the 
least pain being experienced. The peripheral nerves, sensory and mo- 
tor, are not affected by the systemic action. The muscles after poison- 
ing respond energetically to the usual forms of stimulation. It follows, 
then, that the action of the poison is centric and not peripheral (Sal- 
kowsky, Lemaire, Rothe). 

The elimination of carbolic acid takes place by various channels 
of excretion, chiefly by the urine. It may be detected by the odor in 
the breath of poisoned animals (Lemaire). It has been found in the 
saliva by Hoppe-Seyler, but Bill could not detect it in the perspiration 
or in the f asces. Hoffmann maintains that carbolic acid undergoes oxi- 
dation in the blood, but, as a part of it may be separated unchanged 
from the urine, this statement is not wholly true. That much of the 
carbolic acid taken is oxidized before being excreted is proved by the 
character of a secondary product which appears in the urine. One of 
the earliest indications of the toxic action of carbolic acid, especially 
when applied locally, is a dark-greenish, blackish, or smoky hue of the 
urine. Although this appearance does not actually prove that danger 
to life is imminent, it is a warning to be heeded. One of the results 
of the oxidation of carbolic acid is the formation of oxalic acid. The 
same process takes place in animals, in whom carbolic acid is excreted 
as oxalic. Doubt has been thrown on the methods by which carbolic 
acid is detected in the urine of those taking it, through the experiments 



CARBOLIC ACID. 521 

of Stadclcr, who has discovered that carbolic acid is present in normal 
urine. Hoppc-Seyler, however, has proved that, by Stadeler's process, 
carbolic acid is made from the indican of the urine (Hermann). The 
elimination of carbolic acid taking place through so many channels is 
readily effected, and probably the whole amount is thrown out in 
twenty-four hours. When death occurs very quickly in fatal cases of 
poisoning, the tissues and organs will smell distinctly of the poison 
(Ogston). Death has occurred in a few minutes — in a great majority 
of the fatal cases within two hours (Jeffreys), and is rarely postponed 
to two days. The amount of carbolic acid present will therefore vary. 

There are no characteristic post-mortem appearances, except the 
changes wrought at the points of contact with the acid. The mucous 
membrane of the mouth, fauces, oeso2Dhagus, and stomach, where acted 
on, appears corrugated, tough, and discolored — whitish changing to 
brownish discoloration, surrounded by a zone of hyperaemia, or capil- 
lary haemorrhages here and there detaching. Congestion of the viscera 
generally, especially of the brain and the meninges, is a constant phe- 
nomenon. The lungs are oedematous as Avell as congested. The heart 
may be distended with loose clots, and relaxed, or empty and con- 
tracted. By some observers changes akin to those of phosphorus- 
poisoning have been uniformly discovered (Neumann), i. e., acute fatty 
degeneration of liver, heart, kidneys, and other organs, notably the 
renal epithelium. Husemann, Saikowsky, and others, deny the reality 
of these observations, so that further examinations are necessary to 
determine this point. 

Therapy. — Nciusea and vomiting due to an irritable state of the 
stomach- nerves are relieved by carbolic acid. Combination with bis- 
muth enhances the effect, R . Acidi carbolici, grs. iv ; bismuthi sub- 
nitrat., 3 ij ; uracil, acacias, 3 j ; aquae menth. pip., 3 iij. M. S. A 
tablespoonful every two, three, or four hours. Attacks of cholera-mor- 
bus and cholera infantum are not unfrequently very promptly arrested 
by the exhibition of carbolic acid, or the combination of carbolic acid 
and bismuth. Eructations of gas, due to the fermentation of foods, and 
the vomiting of yeast-like matters, especially when due to the pres- 
ence of sarcina, are often arrested by this remedy. Good results 
have been obtained by the use of carbolic acid in Asiatic cholera. 
Combination with iodine is said to be more effective (Choleratropfen). 
R. Acidi carbolici, grs. iv ; tinct. iodinii, gtt. xvj ; aquas menth. pip., 
3 iv. M. S. A tablespoonful every hour, or oftener. The same for- 
mula has been used successfully in cholera nostras and cholera infan- 
tum (Rothe). 

Based on its power to arrest the action of ferments, carbolic acid 
has been used, with certainly temporary good results, in diabetes of 
hepatic origin (Ebstein, Habershon). 

Inhalations of carbolic-acid spray possess a high degree of utility in 



522 ANTISEPTICS. 

chronic nasal catarrh, hay-asthma, chronic bronchitis, and whooping- 
cough. A solution in water, to the proportion of one per cent., is a 
suitable solution for this purpose. It may be combined with the tinct- 
ure of iodine. The efficacy of these inhalations in hay-asthma and in 
whooping-cough is probably due to the fact that carbolic acid destroys 
the minute organisms (cacobacteria, pollen), on the presence of which 
the morbid action in these maladies depends (Letzerich). The vapor 
of carbolate of iodine may be inhaled in these diseases. The warmth 
of the hand suffices to vaporize a mixture of carbolic acid and tincture 
of iodine. 

In pulmonary phthisis when there is much teasing cough, or when 
expectoration is profuse and foul-smelling, these inhalations are ser- 
viceable. In gangrene of the lung, carbolic spray and the acid inter- 
nally are used to destroy the fetor. A one-per-cent. solution of car- 
bolic acid and a mixture of carbolic acid and iodine have been injected 
with asserted advantage into phthisical cavities through the parietes 
of the thorax. 

Internally, also, creosote and carbolic acid, especially the former, 
have been used with conspicuously good results in the treatment of 
the several forms of consumption, except phthisis florida. Probably 
the most useful observations to illustrate this point are those of MM. 
Bouchard and Gimbert. They used pure creosote from wood, and in the 
following formula : Pure creosote, 13.5 parts ; tincture of gentian, 30 
parts ; alcohol,* 250 parts, and sufficient Malaga wine to make up a thou- 
sand parts. Of this solution from two to five' tablespoonfuls are taken 
daily. In other cases the creosote was given in cod-liver oil, which is 
an excellent vehicle — 2 parts of pure creosote to 150 parts of cod-liver 
oil. The daily quantity varied from six to nine grains, and in rare 
cases from twelve to fifteen grains. Of ninety-three cases of phthisis 
treated with this remedy twenty-five were apparently cured, twenty- 
nine were improved, eighteen remained no better, and twenty-one died. 
Creosote thus had a good effect in fifty-four out of ninety-three cases. 
The evidences of improvement consisted in the diminution of the ex- 
pectoration, cough, and fever, and increase in the appetite, strength, 
and weight of body. The diminution of the expectoration, and conse- 
quently of the cough, was the first evidence of improvement, although 
at the beginning of the treatment the cough is apt to be increased for 
a short time by creosote. If the cough and expectoration are con- 
stantly increased, the medicine must be stopped. The danger of 
haemoptysis is rather lessened than increased by the creosote treat- 
ment. Schnitzler, of Vienna, has employed, recently, the subcutane- 
ous injection of carbolic acid in more than one hundred cases of con- 
sumption. He practised the injections daily, sometimes twice a day, 
administering each time from one-eighth to one-fourth of a grain. 
The result was, in most cases, the fever was reduced, the pulse became 



CARBOLIC ACID. 523 

slower and stronger, and the night-sweats were diminished. He con- 
cludes that these injections are as effective, nearly, in relieving hectic 
as quinia, if not more so. 

Influenced hy the germ theory of disease, carbolic acid has been 
much prescribed in the treatment of typhoid fever, diphtheria, scarlet 
fever, erysipelas, etc. Whether the theory be true or false, there can 
be no doubt of the good effects of creosote and of carbolic acid in 
these diseases. Pecholicr, of Montpellier, has given creosote in sixty 
cases of typhoid, set apart for study of the results of the action. Good 
effects were obtained ; the temperature kept down ; the delirium and 
insomnia were much less ; the intestinal disturbance declined, and 
thus the violence of the disease was distinctly lessened. M. Chapelle 
maintains that it cuts short an attack of tyjmoid. In the other mala- 
dies above named, the evidence of the good effects of carbolic acid is 
constantly accumulating. Besides the internal administration, local 
application to the fauces of spray, or suitable solutions, are useful in 
diphtheria and scarlet fever to remove fetor, and to destroy the germs 
of contagion which may be lodged there. Recently Rothe has treated 
a number of cases of typhoid fever, with great success, by a mixed 
antiseptic and antipyretic method, in which he employs carbolic acid 
and iodine administered in infusion of digitalis. The author has for 
several years treated the cases of typhoid and typho-malarial fever 
so called, which have been in his hands, with a drop each of tincture 
of iodine and liquefied carbolic acid every two or three hours, with 
results which were certainly most favorable. As Rothe has observed, 
this antiseptic treatment lowers the heat, lessens the diarrhoea, im- 
proves the mental state, and, indeed, diminishes the severity of the 
disease remarkably. The value of carbolic acid as a remedy in mala- 
rial fevers seems now conclusively established. The experiences of 
Eisenstein in the Vienna General Hospital are especially valuable. He 
obtained distinct curative effects in twenty-four cases of the tertian 
and in four cases of the quotidian type of intermittents. The author 
has found the combination of carbolic acid and iodine of great value 
in chronic malarial infection, and in the more acute cases after quinia 
has stopped the paroxysms. As an antipyretic, Eisenstein justly re- 
gards carbolic acid as inferior to salicylic. It is probable that resor- 
cin, hydroquinone, and other phenols, will prove more useful than 
either. 

The dose of carbolic acid for internal use ranges from half a grain 
to two grains, or of the liquefied acid from half a minim to two min- 
ims. It may be given in mint-water, which covers the odor somewhat. 
This quantity may be repeated every hour or two if necessary without 
producing ill effects, if not too long continued. As mentioned above, 
the quantity given by Bouchard and Gimbert sometimes reached as 
high as fifteen grains a day. The mixture of bismuth, mucilage, and 



524 ANTISEPTICS. 

glycerine, is an excellent vehicle. "When iodine and carbolic acid are 
given together, a colorless carbolate is formed when they are dropped 
into water. 

Parenchymatous Injection op Carbolic Acid. — The deep-seated 
injection of carbolic acid has been proposed and successfully practised 
for the relief of various morbid states. For this purpose a two-per-cent. 
solution is most suitable. A solution stronger than this may excite 
inflammation in the part and coagulate the blood. It is directed by 
Hiiter that the needle of the hypodermic syringe be first inserted into 
the inflamed part, and, if no blood flows out through the needle, it will 
be known that a vein has not been penetrated. From twenty to thirty 
minims of the solution are then injected. The injections are made once 
or twice a day in acute diseases, and on alternate days, or less fre- 
quently, in chronic cases. Very remarkable results have been obtained 
from these injections in erysipelas (Hiiter, Aufrecht) and in pleuro- 
pneumonia (Kunze). 

Dr. Tessier, of the Mauritius, reports that intermittents are rapidly 
cured by the injection of three-quarters of a grain of carbolic acid dis- 
solved in twenty minims of water. 

The parenchymatous injection of carbolic acid is more especially 
adapted to the treatment of certain surgical maladies. Hiiter has em- 
ployed this method successfully in lupus, chancroid, secondary syphi- 
litic abscesses, zdcerations, synovitis (injected into the affected joint), 
fistidce, enlarged bursa?, hydrocele, etc. Levis, of Philadelphia, cures 
hydrocele by injecting liquid carbolic acid into the sac after drawing 
off the fluid. He first inserts the needle of the syringe so that it may 
be certain the point rests in the cavity. Then the fluid is drawn off, 
and finally the acid, a drachm or two, is injected through the needle. 

Local Application op Carbolic Acid. — Itching of the skin, aris- 
ing from any cause, is allayed by sponging the part with a solution of 
carbolic acid. I£. Acid, carbol., 3 ij ; glycerini, §j; aqua? ros?e ad 
3 viij. M. Sig. Lotion. This application is especially serviceable in 
prurigo and prurigo sinalis. Carbolic acid is an effective application 
in parasitic skin-diseases — pityriasis versicolor, tinea tonsurans, tinea 
circinata, favus, scabies, etc. IJ . Acid, carbol., 3 j ; glycerini, 3 j. 
M. S. Loccd application for parasitic sJcin-disedses. The internal 
administration of carbolic acid should be conjoined with its local use 
in prurigo, chronic eczema, and sycosis parasitica. 

The following is an efficient local application for chilblains: IJ,. 
Acid, carbol., 3 j ; tinct. iodinii, 3 ij ; acid, tannici, 3 ij ; cerat. sim- 
plicis, 3 iv. M. Sig. Ointment. 

Undiluted carbolic acid is used as a mild escharotic to the so-called 
mucous patches, to condylomata, vegetations, etc., lupus, scirrhus, cau- 
liflower-growth's,, etc. The author has witnessed results which appear 
to him to justify the statement that carbolic acid, applied undiluted to 



CARBOLIC ACID. 525 

tbe cancerous sore and injected underneath, limits the extension and 
retards the growth of the disease. 

Undiluted carbolic acid is an efficient application to ulcers of the 
cervix uteri, chronic endo-cervicitis, and endo-metritis. It may be 
applied undiluted without risk to the mucous membrane of the uterine 
cavity, on the cotton-wrapped probe, after preliminary dilatation of 
the canal. There is, probably, no better means of treating uterine 
catarrh. 

Solutions of carbolic acid, of average strength, have the power to 
check suppuration, and to correct the fetor of sloughing and ill-condi- 
tioned wounds. The methods of Mr. Lister's antiseptic treatment in- 
clude a much more extended application of carbolic acid. Embracing 
the fermentation theory of M. Pasteur, Mr. Lister holds to the necessity 
of excluding germs from contact with wounded surfaces. Operations 
by the method of Mr. Lister must be performed under and in a spray 
of carbolic acid (one part to forty). The solution may be pulverized 
by the ordinary hand-ball anatomizer, or better by a Siegle's steam 
atomizer. All knives, sponges, and ligatures, must be " carbolized " 
before coming into contact with the wounded surface. The antiseptic 
dressing is thus described by Mr. Lister : " It consists of two pieces 
of folded gauze and mackintosh (fine cotton cloth with a layer of 
caoutchouc), an anterior and a posterior one. The wound is covered 
with several thicknesses of gauze dipped in a solution of carbolic acid 
(one to forty), and over this is placed the folded gauze and mackin- 
tosh, of sufficient size to extend beyond the margins of the wound in 
all directions." The dressing is confined by turns of a " gauze band- 
age," and is allowed to remain undisturbed for from two days to a 
week, " the general rule being that the dressing should be changed on 
any day on which the discharge is observed to have extended beyond 
the edge of the folded gauze." 

Antiseptic gauze consists of cotton cloth charged with the following : 
" One part of crystallized carbolic acid, five parts of common resin, and 
seven parts of solid paraffin " — the paraffin and resin are first melted 
together, and the acid is then incorporated by stirring. A very com- 
plicated process, too elaborate for insertion here, is described by Mr. 
Lister, for diffusing the above-described mixture equably through the 
cotton cloth. For lubricating instruments, especially catheters and 
bougies, he advises a solution of one part of carbolic acid in twenty 
parts of olive-oil. Carbolized silk sutures are "prepared by immers- 
ing a reel of the silk in melted beeswax, mixed with about a tenth part 
of carbolic acid, and drawing the thread through a dry cloth as it 
leaves the liquid, to remove superfluous wax." 

The following is the University College formula for the preparation 
of carbolic-acid plaster : " Shellac, 75 ; carbolic acid, 25. Melt the 
shellac with 8 of the acid, and the,n add the remaining 17, and mix 



526' ANTISEPTICS. 

thoroughly. The mixture should be spread on linen, and should be 
coated with a solution of gutta-percha in bisulphide of carbon." 

The admirable results in the treatment of wounds obtained by Lis- 
ter have been fully confirmed by various competent observers (Nuss- 
baum, Thiersch, Volkmann, Bardeleben), and, although objectors have 
risen to deny the superiority of the method, it has been shown that 
the ill-success complained of was due to inattention to the various de- 
tails necessary. 

Toxic Symptoms induced by Carbolic Acid whex used ex- 
ternally. — The extraordinary extent to which- carbolic acid is now 
applied in surgical practice renders it necessary to devote some atten- 
tion to the symptoms indicating a dangerous degree of absorption. 
This form of poisoning occurs under two forms : one, sudden, the 
patient sinking into collapse immediately after the dressings are ap- 
plied ; the other, occurring insidiously, after some weeks of treatment 
and applications of the antiseptic dressings. Kuster, of Berlin, relates 
five cases of the first form, in which the patients, after the dressings 
were applied, sank at once into a condition of collapse like the state of 
shock from a most formidable surgical operation. Only one of these 
cases recovered. The diagnosis of this toxic state from surgical shock 
will be referred to presently. In the other form of poisoning the 
symptoms appear gradually, and are apt to be attributed to a com- 
mencing septicaemia. Loss of appetite, nausea, feverishness, headache, 
vertigo, and clonic spasms, are first experienced, prostration sets in, 
and a more or less profoundly comatose state develops. The onset of 
these symptoms, or the depression which initiates the morbid phenom- 
ena in the first form, occurs at a time when more favorable symptoms 
are properly expected. But the diagnosis is arrived at readily by an 
examination of the urine. The change in the color and the peculiar 
odor of the urine observed in carbolic-acid poisoning have been re- 
ferred to, but the chemical tests are more important. According to 
Baumann, we have, in Sonnenberg's test, the best means of determining 
the presence of carbolic acid. This test depends on the fact that any 
carbolic acid in the urine unites with the sulphates to form the sulpho- 
carbolates, and hence it consists in determining the amount of normal 
sulphates present. The urine is first acidulated with strong acetic 
acid, and baric chloride is then added in excess. A copious precipitate, 
consisting,for the most part, of baric sulphate, is formed, if the urine 
is healthy ; but, if it contain carbolic acid, scarcely any precipitate will 
be thrown down, because of the formation of soluble sulpho-carbolates. 
The researches of Baumann have furnished us with an antidote of a 
chemical kind, which may be applied if there is time. He has shown 
that sodic sulphide forms in the body, with carbolic acid, the innocuous 
sulpho-carbolate, and hence a soluble sulphate, as Glauber's salts, will 
be a proper antidote. As, howeve/, the toxic action of carbolic acid 



CARBOLIC ACID. 527 

is very speedy, the chemical antidote may not have time. Under 
these circumstances it will be found, probably, that the physiological 
antagonist is more speedy and' effective. Atropia is apparently a 
most certain antagonist. It has succeeded in some very unpromising 
cases, and in my experiment on animals the results have been most 
favorable to the existence of the antagonism. 

Carbolic acid enters into the composition of Morrell's antiseptic 
fluid, which is used as a disinfectant for general jmrposes, and for the 
preservation of bodies. The following is the formula : "Dissolve 13.5 
parts of arsenious acid and 6.9 parts of sodic hydrate in 15 to 20 parts 
of water ; add enough carbolic acid until the clear fluid, after stirring, 
appears turbid (that is, until the liquid is fully saturated with carbolic 
acid), and dilute with water to make 100 parts." 

Sulpho-carbolates. — Sodii Sulpho-carbolas. Sulpho-carbolate of 
sodium. 

Potassii Sulpho-carbolas ; Calcii, Sulpho-carbolas ; Magnesii Sul- 
pho-carbolas. 

Of these salts, the first-named is the most important. The first 
step in the formation of these salts consists in the production of sulpho- 
carbolic acid, obtained by dissolving one part of crystallized carbolic 
acid in an equal weight of strong sulphuric acid. The next step con- 
sists in the formation of sulpho-carbolate of barium, from which the 
other salts are obtained by double decomposition. 

Sulpho-carbolate of sodium occurs in transparent rhombic prisms, 
which are permanent in the air, dissolve in about five parts of water, 
and are also soluble in glycerine and alcohol. Most of the sulpho- 
carbolates have a faint pinkish tint, and are, like the soda-salt, soluble 
in water, alcohol, and glycerine. The dose for internal administra- 
tion ranges from ten to thirty grains. Saturated or weaker solutions 
may be employed topically. 

These preparations, devised by Dr. Sansom, were intended to secure 
the antiseptic and antipyretic action of carbolic acid without any of 
the caustic and depressing action of the latter. In such septic diseases 
as diphtheria, the eruptive fevers, puerpercd fever, they may be used 
freely. There seems little ground for the assumption that the carbolic 
acid is freed from its associates in passing through the organism, for 
the sulpho-carbolates do not have the effects of carbolic acid, and the 
urine does not have the greenish, blackish, or smoky hue characteristic 
of the latter remedy. There can be little doubt that the sulpho-car- 
bolates are excellent topical applications to the inflamed mucous mem- 
brane, wherever accessible. The author has had good results from 
their use in acute inflammation of the fauces, in tonsillitis, in catarrh 
of the a a res, in otorrhcea, and also in gonorrhoea. These salts are 
useful as deodorant and antiseptic applications to unhealthy wounds 
and ulcerated surfaces, to aphthae in children, etc. Although the 






528 " ANTISEPTICS. 

sulpho-carbolate of sodium has been added to the new pharmacopoeia 
list, it must be admitted that the sulpho-carbolates do not maintain the 
position to which they were first introduced. 

Authorities referred to : 

Aufrecht, Dr. E. Schmidt's Jahrbucher, vol clxiv., p. 147. 

Bill, Dr. J. H. American Journal of Medical Science, October, 1870. 

Declat, Dr. G. Nouvellcs Applications de I'Acide Phenique, etc., Paris, 1865. 

Eisenstein, Dr. Von Kitter. Wiener Med. Presse, No. 35, 18*78. 

Gimbert et Bouchard. Gaz. Hebdom., Nos. 31, 33, 1877. 

Grote, Dr. C. H. Diss. Berolini. Die Carbohaure in dcr Median. 

Habershon, Dr. S. 0. Guy's Hospital Reports, vol. xv., 1869-70, p. 530. 

Hoppe-Seyler, F. Schmidt's Jahrbucher, vol. civ., p. 273. 

Husemann, Dr. Theod. Deut. Klinik, 1870 and 1871. 

Hueter, Dr. 0. Schmidt's Jahrbucher, vol. clxiv., p. 144. 

Kohler, Dr. II. Handbuch der physiologischen Therapeutik, 1876, p. 1206, etscq. 

Kunze, Dr. C. F. Schmidt's Jahrbiichei; vol. clxiv., p. 147. 

Lemaire, Dr. Jules. De I'Acide Phenique, Paris, 1863, pp. 754. 

Letzerich, Dr. Ludwig. Virchow's Archiv, Band lx., p. 409. 

Ibidem. Band lvii., p. 518. 

Lister, Dr. Joseph. Tlie Lancet, vol. i., 1875. 

Ibidem. Hie British Medical Journal, vol. ii., 1875, p. 769. 

Neumann, Dr. Isidor. Schmidt's Jahrbucher, vol. cliii., p. 141. 

Eothe, Dr. C. G. Die Carbohaure in de>- Medicin, Berlin, 1875, p. 63. 

Salkowskt, Dr. Schmidt's Jahrbucher, vol. civ., p. 272. 

Taylor, Dr. W. E. Philadelphia Medical Times, vol. ii., p. 284. 

Taylor, Dr. A. S. On Poisons, third edition, 1875, p. 243. 

Salicin. — A neutral principle — a glucoside — contained in the bark 
of several species of salix, and of other trees and plants. It crystallizes 
in plates, 'or in the rhombic system, is whitish in color, bitter to the 
taste, and neutral in reaction (Husemann). It is sparingly soluble in 
water. Dose, grs. v — grs. xxx. 

Actions and Uses. — Salicin promotes appetite and the digestion — 
properties which it possesses in common with other bitters. It is an 
antiferment, and has antiseptic powers similar to quinia and salicylic 
acid. The latter is a derivative of salicin. It is destructive to bac- 
teria and vibrio, and prevents the reaction of amygdalin and emulsin, 
and of ptyalin on starch. It does not produce very sensible effects 
even in large doses, and is without toxic activity. It has been used 
as a substitute for quinia in .the cases of disease to the treatment of 
which the latter is applied, especially in the treatment of intermittents. 
It is, however, much inferior to quinia. 

Salicin is an excellent stomachic tonic in atonic dyspepsia, and is a 
serviceable remedy to prevent the fermentations which take place in 
the foods in cases of gastro-intestinal catarrh. In the chron ic diarrhoea 
of children, it has been employed successfully. The good results ob- 
tained from it in these cases are doubtless due to its antiferment prop- 
erties and its lack of irritating qualities. 



SALICYLIC ACID. 529 

The most important use of salicin thus far proposed, is in the treat- 
ment of acute rheumatism — information which we owe to Dr. Mac- 
lagan. He concludes, as the result of his experience, that the more 
acute the case the more beneficial the remedy ; that the good effects 
are always experienced within forty-eight hours ; that, sometimes, the 
disease is at once arrested ; that relief of pain and fall of temperature 
are the earliest effects produced. Maclagan gives from ten to thirty 
grains every two, three, or four hours, in powder mixed with water. 
"Fifteen grains every three hours is a medium dose." 

Authorities referred to : 

Hosemann, Dks. Aug. und Theod. Pflanzcnstoffe, p. 959, ct seq. 
Maclagan, Dr. T. The Treatment of Acute Rheumatism by Salicin. Tlie Lancet, 
March, 1876. 

Acidum Salicylicum. — Salicylic acid. Acide salicylique, Fr. ; 
Salicylsaure, Ger. 

Properties. — Salicylic acid crystallizes in needle-shaped crystals, 
which are soluble in alcohol and ether, and in hot but not in cold 
water. It is without smell, and its taste is slight and not disagree- 
able. The solubility of salicylic acid in cold water is increased by the 
presence of neutral salts. Three parts of phosphate of sodium will 
render one part of the acid easily soluble in fifty parts of water. Bo- 
rate of sodium is still more efficient in promoting the solubility of the 
acid, and, as boracic acid has properties corresponding to salicylic, the 
borate should be preferred for this purpose. It has been shown that 
ten parts of salicylic acid can be dissolved in one hundred parts of 
water, by the addition of eight parts of borax (Bose). The borax 
should be first dissolved by the aid of heat, and the salicylic acid 
should be added gradually to the hot solution of borax. On cool- 
ing, filtration is necessary to separate a small quantity of undissolved 
residue. 

. The dose of salicylic acid for internal administration ranges from 
ten grains to one drachm. 

Sodii Salicylas. — Salicylate of sodium. Dose, grs. xv — 3 j. The 
best mode of administration is in the form of wafer, containing five 
to ten grains. These may be given rapidly until the requisite quan- 
tity has been swallowed. Salicylate of soda may be prepared extem- 
poraneously by the addition of salicylic acid to a solution of bicarbonate 
of sodium. If the alkali is in excess, the resulting solution is brown- 
ish or purplish in color, and has a strong odor of wintergreen. This 
is not repulsive to most patients. 

Antagonists and Incompatibles. — The mineral acids, the me- 
tallic salts, and the preparations of iron in general, are chemically in- 
compatible. From the physiological standpoint, salicylic acid and 
35 



530 ANTISEPTICS. 

the salicylate of soda are antagonized by the arterial and cerebral 
stimulants. 

Synekgists. — The effects of salicylic acid are increased in all di- 
rections by the members of the phenol group, by the arterial depres- 
sants, and by the anaesthetics and cerebral sedatives. 

Physiological Actions. — In small doses, salicylic acid may stimu- 
late digestion, but in considerable quantity, especially if frequently 
repeated, it causes uneasiness at the epigastrium, nausea, and vomit- 
ing. This inability of the stomach to dispose of the large doses of- 
salicin, salicylic acid, and salicylate of soda, required in the treatment 
of certain diseases, is an obstacle to their use. They are diffusible and 
readily enter the blood. It is in a high degree probable that salicylic 
acid combines with an alkaline base and enters the blood as a salicyl- 
ate — as a salicylate of sodium, according to Salkowski. Binz holds 
that the free carbonic acid present in the blood must effect the separa- 
tion of salicylic acid from its combinations, and hence that salicylate 
of soda must act as salicylic acid. It is well known, of course, that 
salicylate of soda does not possess the antiseptic property of salicylic 
acid, and, as both act similarly after their medicinal administration, it 
seems highly probable that the decomposition just mentioned does 
actually take place. An observation of Kohler seems to support the 
theory of Binz. Kohler found that, while ordinary blood containing 
salicylic acid did not yield it up to ether, the blood of asphyxia which 
contains an exceptional quantity of carbonic acid, did yield up its 
contained salicylic acid to ether. The blood in the vessels unques- 
tionably contains more carbonic acid than that which has been exposed 
to the air. Salicin, as Senator first demonstrated, under the action of 
ferments, splits up into saligerine and glucose, and saligerine is readily 
oxidized into salicylic acid. This process is supposed to occur in the 
body, and hence the comparative slowness of action of salicin and 
similarity in its effects to salicylic acid. Spencer, examining the blood 
of a person taking salicin, only got evidence of the presence of the 
glucoside but not of the salicylic acid, and in the urine of the same 
subject found but a small part of the acid which ought to have ap- 
peared, whence he concludes that the conversion of salicin into sali- 
cylic and salicyluric acids, according to Senator, is but partially accom- 
plished in the organism. These observations adequately explain the 
superior activity of salicylic acid as compared with salicin. 

In health, ordinary doses of salicylic acid and salicylate of sodium 
have but little effect on the circulation. In the carefully conducted 
experiments of Ringer and Morshead, made on normal subjects, con- 
siderable doses of the acid increased the pulse-rate from ten to twenty 
beats, but more or less f everishness was produced by the irritant ac- 
tion on the gastro-intestinal mucous membrane. The manometric 
studies of Kohler demonstrated that this agent lowers the blood-press- 



SALICYLIC ACID. 531 

ure, and this result occurred after division of the vagi, the depressors, 
and the spinal cord, whence it must be concluded that it accomplishes 
this result by a direct action on the heart and vaso-motor ganglia. 
More recent observations by Oltramare show that when salicylic acid 
is thrown into the veins the first effect is to increase the energy of the 
systolic contractions, the number of pulsations, and the blood-pressure. 
These effects, he finds, are due to a direct stimulation of the heart and 
of the motor centres. Under the influence of increasing doses, the 
vessels dilate, the blood-pressure falls, and finally the heart is arrested. 
There is, therefore, a general agreement as to the increase of the ac- 
tion, lowering of the blood-pressure, etc., as studied in animals, and 
observed on man by Ringer and Morshead. Professor See, however, 
fails to discover any effect by salicylic acid on the heart or blood-press- 
ure, but, as he administered the remedy by the stomach, it is probable 
that he did not secure admission to the blood of a sufficient amount. 

Tbe numerous observations made on the effect of salicylic acid and 
salicylates ou the heat-function are in close accord. In health it is found 
that, unless toxic doses are taken, the temperature is but slightly or not 
at all affected. Riess, one of the first .to make observations on this 
point, noted a constant reduction of the normal temperature ; but See, 
Ringer, Fttrbringer, and others, agree that in health this agent does 
not affect the temperature. Riess's conclusions were based on more 
than four hundred observations of the internal use of salicylic acid, and 
in twenty-three cases he ascertained a reduction of 1.6° Fahr., produced 
by five grammes (nearly eighty grains). If fever is present, whether 
produced artificially by the injection of septic materials, or arising spon- 
taneously, salicylic acid very uniformly effects a considerable reduction. 
The result, however, is not always the same. That salicylic acid has 
a decided antipyretic action is denied by Zimmermann, Wolffberg, 
and some others ; but the weight of testimony is overwhelmingly the 
other way. It is certain that the degree of antipyretic effect varies 
in different forms of fever (Bartels, Senator, Nathan, and others), and 
also according to the individual susceptibility to its action. The phe- 
nomena attending the reduction of temperature are worthy of consid- 
eration. At the onset of the action, in ten to fifteen minutes after the 
dose is swallowed, some increase in the heart's action, a feeling of 
warmth through the system, and flushing of the face with suffusion of 
the eyes are experienced, then the perspiration begins, appearing first 
on the face, then on the chest, abdomen, and extremities, and presently 
becomes profuse. Coincidently with the sweat, the decline in tem- 
perature begins, but it continues after the sweating. There is no 
ratio between the amount of sweating and the reduction of fever-heat, 
for with much sweating there may be but slight diminution in the 
temperature, and with little sweating a marked decline. In febrile 
cases the decline of temperature varies from 1° to 6° Fahr. (Riess, 



532 ANTISEPTICS. 

Nathan, Bartels, Ewald, and others). The quantity of salicylic acid 
necessary to effect any considerable reduction of temperature ranges 
from one to two drachms. The effect is maintained from five to 
twenty hours, when a repetition of the dose usually becomes necessary. 
With the first effect of the agent on the heart, the pulse rises, but, 
as the sweating progresses, more or less slowing of the heart-beat 
occurs. There are differences of opinion, however, on this point. 
Thus, Ewald, Riess, Goltdammer, and a few others, hold that the pulse 
is little if at all affected ; but the usual expression is that, after a pre- 
liminary rise, there ensues with the perspiration and lowering of the 
temperature a marked decline in the pulse-rate (Buss, Stargard, Nathan, 
Moeli, etc.). 

With the first impression of this agent on the respiratory centre, 
the number of respirations is increased, but, with the decline of tem- 
perature and of the pulse, they are lessened. The excretion of car- 
bonic acid, Livon shows, is the greater, the larger the dose of salicylic 
acid, estimated during the period of increased action of the lungs. 
Under the influence of large doses, accumulation of the acid takes 
place in the cerebro-spinal fluid, causing an excitation of the roots of 
the pneumogastric nerve, but the excitation is succeeded by the de- 
pression which terminates in arrest of the respiratory function. 

As the effects of salicylic acid or salicylate of sodium develop, more 
or less headache, with a feeling of distention and frontal oppression, is 
experienced. Buzzing in the ears, dullness of hearing, and even deaf- 
ness, are usual symptoms when the doses are large. Vision is also 
affected, the sight becoming dim, or strabismus or ptosis occurs. In 
one case sudden and complete amaurosis came on (Gatti) after the ad- 
ministration of one hundred and twenty -five grains of salicylate of 
soda ; the pupils were widely dilated, the sclerotic and cornea acquired 
extreme sensibility, but the retina was unchanged, and the vision for- 
tunately was restored after ten hours without impairment. In other 
cases, subacute delirium, or delirium with refusal of food, and various 
delusions (Daly) have occurred while patients were taking consider- 
able doses. Ordinarily, however, the cerebral effects of salicylic acid 
are not unlike those of quinia. The state of the intracranial circula- 
tion which it induces has not been studied. According to Blanchier 
and Rochefontaine, salicylate of soda depresses the functions of the 
central nervous system, but the irritability of both sensory and motor 
nerves and the contractility of muscle remain unimpaired. 

Animals, to whom salicylate of sodium is administered daily for 
some time, emaciate rapidly (Chirone and Petrucci). The toxic dose 
for the dog, ass, and horse, according to Oltramare, is one gramme 
per kilogramme of the body-weight. Death is due to paralysis of the 
heart, and not from asphyxia, as has been heretofore supposed (Oltra- 
mare). After death the abdominal viscera are intensely congested, 



SALICYLIC ACID. 533 

unless the medulla be divided, when a marked degree of anaemia suc- 
ceeds to the hyperemia. It is this fact chiefly which induces Oltra- 
mare to maintain that salicylate of sodium acts on the vaso-motor 
centre in the medulla. 

On man as well as on animals sometimes salicylic acid produces se- 
rious symptoms. The intoxication, with delirium and delusions which 
it causes in certain subjects, especially those suffering from acute rheu- 
matism, has been referred to. In drunkards it is especially apt to act 
unfavorably, bringing on in them violent delirium. In rare instances 
salicylic acid and the salicylates have induced a condition of collapse, 
with restlessness, delirium, great dyspnoea, feeble pulse, and involuntary 
evacuations. The vaso-motor paresis, which is a result of large doses 
in feeble subjects, may be accompanied by great relaxation of the skin, 
the rapid formation of bed-sores, etc. Dr. Tuckwell, of the Radcliffe 
Infirmary, Oxford, gives the following symptoms as occurring in two 
cases under his observation : " Loud, deep, and sighing respiration ; a 
strange restlessness, gradually increasing to delirium, and not unlike 
that of delirium tremens, with involuntary evacuation of urine and 
fa2ces in the worst of the two cases ; a slow and laboring pulse ; an 
olive-green color of the urine." No fatal case, distinctly due to these 
preparations, has been reported, but many have occurred in which very 
dangerous symptoms arose ; but, fortunately, all disappeared on stop- 
ping the administration of the remedy. The existence of albuminuria 
is an important factor in the causation of bad results (Huber). 

The rate of diffusion of salicylic acid has been closely studied by 
Blanchier and Rochefontaine, with the following results : When in- 
jected into the veins of a dog, salicylate of soda appeared in the saliva 
in four to five minutes ; in the urine, eight to ten minutes ; and in the 
bile and pancreatic secretion, in fifteen to twenty minutes. "When 
taken into the stomach, it appeared in the saliva in twenty minutes, 
and in the urine in forty-five minutes. In man salicylic acid is ex- 
creted chiefly, almost wholly, by the kidneys, and appears in the urine 
in twenty minutes after it is taken into the stomach. It is excreted 
as salicyluric acid, which may be seen as a deposit at the bottom of 
the vessel, "of a white, feathery consistence." The urine presents a 
more or less deep greenish tint. The presence of the acid is readily 
ascertained by the solution of chloride-of-iron test. To the urine sus- 
pected to contain salicylic acid, add slowly, drop by drop, the chloride- 
of-iron solution ; phosphate of iron is first formed, which is whitish in 
color, but presently, if salicylic acid be present in a free state, a violet 
"color is developed. The urine, during a course of the acid or of the 
salicylates, frequently contains albumen, due, doubtless, to the irrita- 
tion of the kidneys as elimination is going on. The facts do not yet 
warrant any conclusion in regard to the damage which may be perma- 
nently inflicted on the kidneys by the prolonged administration of this 



534 ANTISEPTICS. 

agent. The influence over the urinary excretion has been examined 
by Bouchard. There is reason for believing that the urinary water is 
not augmented, the extractives are somewhat increased, and the phos- 
phates and coloring-matter are unchanged. Prof. See finds that the 
excretion of uric acid in gouty cases is promoted. It is maintained 
by others that the amount of urea present in the urine is greater than 
normal. Livon and J. Bernard have ascertained that salicylic acid, 
■ after being thrown into the stomach or into a vein appears within an 
hour or two in the saliva, milk, pancreatic secretion, bile, as well as 
urine, and it was always found in the cerebro-spinal fluid. They con- 
clude that it acts locally at these points of contact with the structure of 
organs. Hence, it appears highly probable that the local stimulation 
increases the product of those glands through which the acid or its 
salt passes, but not in the urine, if Bouchard's observations can be re- 
lied upon. Albuminuria, according to Gubler, is produced by it in 
some cases, and temporary impotence has been observed in others. 

Therapy. — The applications of salicylic acid in the treatment of 
disease are based on the results of the physiological examination. In 
the diseases of the stomach characterized by fermentative changes in 
the food, as in catarrh, dilatation of the organ, etc., salicylic acid is an 
effective remedy. The author has seen admirable results from its use 
in gastralgia, even when distinctly periodical. In the vomiting of a 
pasty fermentating mass of ingesta, whether or not accompanied by 
the organism, sarcina, or other germs of fermentation, good results 
are derived from this remedy. In these stomachal disorders, the best 
effects are had from ordinary doses (five to ten grains), given in a wafer, 
either in anticipation of the attack — as of gastralgia appearing at a 
fixed hour — or during the process of fermentation in the stomach con- 
tents. As a portion of the remedy taken passes into the fceces, it is 
probable that salicylic acid is just as effective in the corresponding 
troubles in the intestines. Ilgin reports the removal of taenia solium 
in six cases by the administration of salicylic acid, in eight-grain doses 
every hour until five doses were taken — preceding and following the 
acid with a dose of castor-oil. It has been employed successfully in 
the removal of ascarides, by local application and by internal adminis- 
tration. An enema of water should precede the salicylic-acid solution, 
which may be composed of borax and salicylic acid with some gly- 
cerine. I£. Acid, salicylic, 3 ss ; sodii biborat., 3 ss ; aqiue, Oj. M. 
S. Warm, and administer the whole amount at one time. For a 
young child, this quantity should be reduced one-half, or more. 

"When the" heart is weakened from any cause, salicylic acid and 
salicylate of soda must be exhibited with caution. The experience 
thus far accumulated warrants the assertion that the dose of fifteen 
grains of the former and twenty of the latter should rarely be ex- 
ceeded, if frequent repetition of the dose is practised. From Riess, 



SALICYLIC ACID. 535 

-who regards salicylate of soda as a specific in typhoid fever, to Filatow, 
■who holds that it is worse than useless, there are various shades of 
opinion, with the weight of authority decidedly in favor of the view 
that it is a remedy of real value. Since Kiess, no one has claimed in 
this remedy a specific for typhoid, but it is generally admitted that it 
renders the course of the disease milder by keeping the temperature 
within safe limits (Tomkins, llallopeau, Butt, Immermann, Senator, 
etc.). Weiss concludes, after an experience of ninety-six cases of ty- 
phoid in children, treated with salicylate of soda, that it is a powerful 
antipyretic in the typhoid -of children, and that, while it does not 
shorten the course of the disease, it renders it much milder. He finds 
that the results are better, when the typhoid of children is treated by 
salicylate of soda, than have hitherto been obtained from quinine and 
cold baths. A still more recent English experience is to the same 
purport as the German. Dr. Tomkins finds that in the salicylates 
we have the means of reducing fever-heat, more certain and more 
agreeable than by the cold bath. In the eruptive fevers, the same 
principles obtain as in tyjmoid. Salicylate of soda is preferable to 
salicylic acid, because it is less irritating, safer, and equally effective 
as an antipyretic. The object of its administration is to reduce the 
heat which is the most important source, of danger. The amount re- 
quired to accomplish this object is now definitely known. Twenty 
grains of the soda salt may be given every two hours, until the temper- 
ature is reduced to the proper point, at which it may be held by ten- 
grain doses at the same interval, unless the occurrence of an exacerba- 
tion requires the exhibition of a larger quantity. In the case of chil- 
dren, the daily quantity ranges from half a drachm to a drachm. Prob- 
ably the best mode of administering the salt is in the form of wafer, 
but when these cannot be obtained, a solution may be readily prepared, 
or the salt may be constructed extemporaneously by adding the acid 
to a solution of sodic carbonate as follows : r>. Acid, salicylic, sodii 
bicarbonat., aa 3 iv ; aquae, 3 jss ; syrup, simpl., 3 ss. M. S. A table- 
spoonful contains about twenty grains salicylate of soda. It should be 
borne in mind that this remedy is not safe if the heart is very weak, 
nor if albuminuria is present. 

In relapsing fever, according to Riess, salicylic acid accomplishes 
something more than the mere reduction of temperature. Although 
it does not prevent the usual relapse, even when administered in large 
doses during the interval, it lessens the severity and duration of the 
relapse. It does not destroy the spirilla in the blood, nor indeed 
lessen their activity (Riess), and hence cannot be a curative agent in 
this disease. In pyaemia, septiccemia, puerpei'al fever, diphtheria, 
etc., salicylate of sodium is used under the same rules as in typhoid. 
The indication for its use is high fever, and the good accomplished by 
it, is determined by the degree in which the temperature is reduced. 



536 ANTISEPTICS. 

The antiseptic action is quite secondary to the antipyretic. In mala- 
rial fevers it was supposed by Senator and others, in the enthusiasm 
attending the introduction of the remedy, that salicylic acid would 
prove equal to quinia. If administered in a full dose just before the 
advent of a paroxysm, it will prevent it, but it does not possess the 
curative powers of quinia over the effects of the malarial poison, and 
hence will not prevent relapses. By using salicylate of sodium to 
abort an impending paroxysm, and quinia to prevent relapses, the 
curative result will be attained with the least pecuniary expenditure. 
In the mildest cases of intermittents, salicylate of sodium may be de- 
pended on alone, but, to succeed, it must be administered before the 
expected paroxysm. 

Out of the enormous mass of published experience in regard to the 
value of salicylic acid in acute rheumatism, it is difficult to select. 
From the first trials of Buss, followed by Strieker and Traube, there 
has been an almost unanimous expression of opinion by the German 
physicians in regard to the value of this agent in rheumatism. At 
first it was supposed that the disease could be invariably cut short in 
forty-eight hours to three days, but larger observation has qualified 
these opinions. By way of illustration of the measure of success now 
attained in Germany with salicylic acid in rheumatism, we may take 
the recently published statistics of Diesterweg. Of one hundred cases 
treated with this remedy, the disease was cut short in thirty-six or 
twenty-four hours ; in eighty-five within the period of forty-eight 
hours ; in ninety-eight within seventy-two hours ; in one the disease 
was prolonged to eighty-four hours ; and in one the remedy made no 
impression on the disease. It is not intended to convey the impression 
that the cases got well in so short a time, only that the fever and 
joint-swelling and pain subsided, and convalescence was established. 
Relapses occurred in eleven cases, and cardiac complications in five. 

In France the treatment of acute rheumatism by salicylic acid was 
taken up by Jaccoud, Lepine, Gueneau de Mussy, and others, but es- 
pecially by Prof. See, who has devoted to it several important lectures. 
As a result of See's observation, he concludes that salicylic acid has a 
marked and peculiar benefit in acute rheumatism ; that the pains in- 
variably cease in from twelve to eighteen hours ; that the articular 
swelling disappears at the end of three days, and that the fever sub- 
sides with the pains. If the fever persists, other joints will become 
affected. Out of fifty-two cases treated by Prof. See, fifty-one recov- 
ered in from two to three days. These results are quite equal to the 
German. See makes an important observation in regard to the ra- 
pidity with which salicylic acid and salicylate of sodium are eliminated, 
and the necessity, therefore, of continuing the remedy for some time 
after all the joint-troubles have ceased, to prevent relapses. Prof. 
Gubler does not share the general enthusiasm as to the value of this 






SALICYLIC ACID. 537 

agent in rheumatism. lie emphasizes the uncertainty and the dangers 
attending its use, and maintains that it has no antipyretic effects. 

In England salicylic acid and salicylate of sodium have been used 
with a large measure of success, but the rheumatism of England, as of 
this country, does not yield with the promptness characteristic of the 
Continental disease. The general results of the treatment, as con- 
ducted in England by Broadbent, Carafy, Spencer, Boggs, Greenhow, 
and many others, is very much as expressed by the last-named in his 
important communication to the Clinical Society. The temperature 
speedily falls, sometimes within a few hours and almost always in two 
or three days, the pulse declines at the same time, the pains subside 
correspondingly, and the joint-swelling diminishes and disappears 
within three or four days. Greenhow points out that such a result is 
not a cure even in the most favorable cases ; that the remedy acts 
very injuriously on the heart and causes a deep anaemia, and that, 
therefore, the duration of the disease, from beginning to the termina- 
tion, is not actually shortened. Dr. Maclagan (also Charteris) strongly 
urges the substitution of salicin, on the ground that it is equally effec- 
tive with salicylic acid and much less dangerous, but it is difficult to 
appreciate this argument, since salicin is converted into salicylic acid 
in its passage through the system. 

In this country, the experience of the Maine physicians, and of the 
medical staff of the Massachusetts General Hospital, has been pub- 
lished. It is conceded that it has good effects. As regards the ex- 
perience at the Massachusetts General Hospital, the facts are as follows : 
in eight cases out of seventeen treated with salicylic acid, the duration 
of the longest case was twenty-six days, and the shortest five days, 
the improvement being very marked from the beginning of treatment. 
Of three patients who took salicylate of soda only, the duration of the 
disease was less than twelve days in each case, the shortest being two 
days. In the remaining nine cases the duration was six weeks or 
more. 

In summing up the testimony, it is clear that salicylate of soda is 
a most valuable remedy in acute rheumatism, but various unpleasant, 
even dangerous symptoms arise in some cases. Violent headache, ver- 
tigo, and tinnitus aurium, are common ; wild delirium is an occasional 
symptom ; weakness of the heart, obscuration of the first sound, and 
profound anaemia, are especially noted by Greenhow ; very great gas- 
trointestinal disturbance is now and then produced. Empis narrates 
a fatal case of acute rheumatism which was treated by salicylic acid. 
Great depression of the powers of life, in rare instances approaching 
collapse, has been observed. Sufficient is now known of the danger 
attending the salicylic medication of acute rheumatism, to justify the 
author in urging circumspection on the attention of his readers. The 
robust and vigorous rheumatics are proper subjects for this treatment, 



538 ANTISEPTICS. 

whereas, in the pale, feeble, and cachectic, especially those with weak 
hearts, this treatment must be pursued cautiously, or not undertaken 
at all. Relapses are frequent, probably because of the very rapid 
elimination of the remedy, as suggested by Prof. See, and hence its 
administration must be continued for some time after all of the local 
and systemic symptoms have subsided. 

In gout, chronic rheumatism, myalgia, and lumbago, salicylate of 
sodium often acts most serviceably. It is more effective the more 
acute the malady as a rule, but it sometimes does great good in the 
most chronic cases. Abbott reports the cure of sciatica, and Brun of 
rheumatismal irido-choroiditis, by its use. 

It is a very interesting fact, first distinctly stated by Dr. Pye 
Smith, of Guy's Hospital, London, that, during the administration of 
salicylic acid and the salicylates, the urine exhibits the reaction for 
sugar on the application of Trommer's test. This has been observed 
in rheumatism and in other diseases treated with this agent. The 
urine is a little increased in amount, but its specific gravity is not 
changed. The reduction of the copper is effected by the acid or by 
the glycogen, which is one of the products of the decomposition of 
salicylic acid. Miiller, the assistant of Eckstein in the clinic at Kiel, 
has published some important observations on the use of salicylate of 
soda in the treatment of diabetes. It appears that full doses of the 
salt cause the sugar to disappear entirely, but this is not a permanent 
result, for, after a time, the sugar returns. A very great tolerance to 
the remedy exists in this disease, and large doses may be taken with 
impunity. Bouchardat, in commenting on these observations, states 
that he has not had good results from this treatment. Since, how- 
ever, the remedy is well tolerated, and during its exhibition in consid- 
erable doses the sugar disappears, it may be used with advantage at 
critical times to stop the waste. 

Salicylate of sodium has feeble antiseptic properties, and hence sa- 
licylic acid, which is even superior to carbolic acid in its power to de- 
stroy minute organisms and to prevent change in putrescible materials, 
should be preferred for all topical applications. Being free from odor, 
and more active than cai-bolic acid, it should be used instead of car- 
bolic acid for most purposes. For all toilet purposes it is decidedly 
preferable. It is an excellent addition to the ordinary powder denti- 
frices, and its solution with borax is an efficient deodorant in fetid 
perspiration. This disagreeable affection, as it attacks the feet, may 
be relieved by dusting the feet thoroughly with powdered salicylic 
acid before putting on the stockings. It is useful, also, to fill the in- 
terstices of the stockings with the powder. Extraordinary success has 
been achieved by the local application of this remedy in eczema of the 
head and face. Those cases characterized by much weeping seem to 
be best adapted to the cure by salicylic acid, but eczema rubrum and 



SALICYLIC ACID. 539 

ma impetiginodes, that resisted other approved means, have yield- 
ed to the application of this agent (Wagner, Will). It is generally 
conceded that, as a local application to syphilitic ulcers, salicylic acid 
is inferior to carbolic acid. 

The most important therapeutical uses of salicylic acid arc in the 
antiseptic treatment of wounds and injuries. Since it has been shown 
t hat this agent has a power to destroy the activity of ferments and dis- 
ease-germs equal to that of carbolic acid, while it is free from the irri- 
tating quality and disagreeable odor of the latter, Thiersch, who ifl a 
strong advocate for Lister's antiseptic method, has resorted to the use 
of salicylic-acid solutions. 

To cancer, gangrenous and sloughing vounds, pure salicylic acid 
may be applied in powder. To prevent the contact and multiplication 
of atmospheric germs, operative procedures may be conducted in sali- 
cylic spray, the sponges and dressings may be saturated with salicylic 
solutions, and the wound may be irrigated by the same. In order to 
carry out all the details of the antiseptic method, salicylic acid is sub- 
stituted for carbolic in the forms and combinations of dressings em- 
ployed by Lister. Wounds are covered with cotton-wool, impregnated 
with an alcoholic solution of the acid, in the proportion of three and ten 
per cent. As cold water takes up only one part to three hundred, 
which, however, is strong enough to destroy bacteria, etc., the addition 
of borax is generally necessary to obtain a solution of sufficient strength 
for the antiseptic applications. A salicylic-acid plaster may be prepared 
as follows : Salicylic acid, 3 ss — 3 j ; white wax, 3 j ; paraffin, 3 ij ; 
almond-oil, 3 ij. The ingredients are melted, and rubbed up together 
in a heated mortar (Will), and spread on muslin. An ointment more 
readily melted by the heat of the body is the following : Sperm-oil, 
3jss; cacao-butter, 3 vss; salicylic acid, 3 ss — 3 j. This should be 
melted together, thoroughly incorporated and spread on lint (Will). 
An ointment for the same purposes may be prepared in a simpler way 
by the addition of salicylic acid to simple cerate. A solution of sali- 
cylic acid in olive-oil, in the proportion of one drachm to eight ounces, 
is an efficient local application for burns. 

Authorities referred to : 

Bose, Dr. II. Berliner klinische Wochenschrift, 1875, No. 23. 

Bess, Dr. E. Die aniipyrclische Wirkung dtr Salicylsiiurc. Cent. f. d. med. Wissen- 
schaftcn, 1S75, No. 18. 

Furbringer, Dr. Zur Wirkung dcr Salicylsdure, pamphlet, Jena, 1875. 

Immermann, Prof. Quoted in Liebermeister's Handbuch der Pathologic und Therapie 
des Fiebers, Leipzig, 1875, p. 644. 

Kolbe, Prof. Ucber die antiseptischen Eigenschaftcr der Salicykuurc. Schmidt's Jul, r- 
buehcr, vol. clxiii., p. 229. 

Letzerich, Dr. Ludwig. Experimculcllen Untersuchungen und Beohachtungen uber 
die Wirkung der Salicylsuure bei der Diphlherie. Virchow , s Archiv, Band lxiv., p. 102. 




540 ANTISEPTICS. 

Moeli, Dn. Berliner klinische Woehensehrift, 1875, No. 30. 

Senator, Prof. Dr. Berliner klinische Woehensehrift, No. 32. 

Squibd, Dr. E. Note on Salicylic Acid, Brooklyn, 1875. 

Thiersch, Prof. Dr. Klinische Ergebmsse dcr Lisler'schen Wundbehandlung, etc. 
Volkmann's klinischer Vorlrdge, Nos. 84 and 85. 

Traube, Dr. L. Berliner klinische Woehensehrift, No. 1, 1876. 

Will, Dr. J. C. Ogiltie. On Salicylic Acid. The Lancet, vol. ii., 1875, p. 870, ct 
seq. 

Resorcin. 

History. — Resorcin is a chemical compound, discovered by Hlasi- 
wetz and Barth, and was obtained from certain resins by the action of 
fusing alkalies. They assigned to the new compound the name resorcin, 
partly because it is derived from a resin, and partly because it has 
some similarity to orcin, a peculiar substance obtained from archil. 
Subsequently resorcin was constructed synthetically by Korner, and 
at the present time it is obtained in vai'ious ways, the product being 
both pure and cheap (Andeer). 

Properties. — Resorcin is a member of the phenol group. It oc- 
curs in tabular prismatic crystals, rather shining and lustrous, some- 
what sweetish to the taste, with a little after-pungency. When struck 
or rubbed in the dark, it appears phosphorescent. In odor it is some- 
what like phenol, but not nearly so pronounced. It is freely soluble 
in water, in the proportion of 86.4 parts of resorcin to 100 parts of 
water at 0° C. It is dissolved by all liquids except chloroform and 
carbon sulphide. The best vehicles, according to Andeer, are alcohol, 
glycerine, and sirup of orange. The dose for usual purposes ranges 
from five to fifteen grains. For a decided antipyretic effect a drachm 
may be given, but this amount could not be frequently repeated. Five 
grains may be given every two hours, in an ordinary case. 

Antagonists. — From the physiological standpoint, resorcin is an- 
tagonized by the cerebral excitants, by the agents which raise the 
arterial tension, and by the cardiac and respiratory stimulants — by 
atropia especially. 

Synergists. — Its effects are promoted by quinia, salicylic acid, 
carbolic acid, etc. 

Physiological Actions. — Resorcin does not irritate, nor is it ab- 
sorbed by the unbroken integument. The solution injected into the 
subcutaneous tissues produces but little irritation, and never inflamma- 
tion and abscess. Applied to the moistened mucous membrane, it 
causes vesication, and a white blister forms, like that from carbolic 
acid. It has decided anti-ferment properties, arrests decomposition in 
animal tissues, deodorizes, and is destructive of the minute organisms 
on the presence of which putrefactive decomposition is dependent. A 
one-per-cent. solution will prevent the decomposition of urine when 
exposed to the air for months (Andeer). Applied to unhealthy wounds, 



RESORCIN. 541 

it arrests the decomposition, destroys the fetor, and promotes healthy 
cicatrization (Dujardin-Beaumetz). 

When a considerable dose of resorcin (thirty to sixty grains) is 
administered to a person in a fever, in a few minutes a sense of heat 
is felt about the epigastrium, and spreads thence over the system ; the 
face flushes and grows hot, the eyes glisten, the breathing and pulse 
are accelerated, and dizziness, with ringing in the ears, and frontal 
headache, are experienced. A good deal of discomfort, oppression of 
the chest, and a sense of distention of the head, are usually produced, 
but these sensations subside in from ten to fifteen minutes, the skin 
then grows moist, and in a few minutes more a profuse perspiration 
is pouring out on the surface of the body. The pulse then falls, cool- 
ness succeeds to heat, languor to tension, and the temperature of the 
body declines several degrees. If the feverish state has no special 
features, the lessening of the pulse and reduction of temperature to 
the normal occurs in about an hour. The pulse may be slowed one- 
third, and the reduction of temperature be as much as three or more 
degrees of Centigrade or five degrees Fahr. (Lichtheim). The reduc- 
tion of temperature in fever is of comparatively brief duration, last- 
ing from two to four hours. When the rise of temperature begins 
again, a sense of chilliness is experienced, which may even take the 
form of a distinct rigor. Lichtheim observed great differences in the 
power of resorcin in different fevers. The less the tendency to sj)on- 
taneous remissions, the less the antipyretic effect. The fever accom- 
panying pneumonia and erysipelas was less amenable to the action 
of resorcin than was typhoid fever, but no form of fever entirely re- 
sists its action. 

The preliminary stage of excitement produced by resorcin is often 
accompanied with excitement and delirium. In one case a deep stu- 
por ; in others, muscular trembling and incoherence of speech were 
observed. 

Therapy. — A close correspondence exists in the therapeutical ap- 
plications of the members of the phenol group, and Lichtheim traces 
a distinct parallelism between their anti-fermentative and antipyretic 
action, Resorcin, having much less irritating property, is generally 
preferable to carbolic acid for internal and for subcutaneous use. In 
catarrh of' the stomach, gastralgia, ulceration, and fermentative indi- 
gestion, Andeer reports on a series of three hundred cases in which it 
acted most favorably. He prescribed chiefly a three-per-cent. solu- 
tion. In fevers it has been given with a view both to its antiseptic 
and antipyretic actions. It is not a specific, and is only serviceable in 
the ratio in which it reduces heat. In erysipelas, puerperal fever, septi- 
caemia, and diphtheria, resorcin may exert an antiseptic effect.- For 
the same reason it may be applied to the treatment of idcerative endo- 
carditis. In intermittent fever remai'kable results have been lately 



542 ANTISEPTICS. 

obtained, which, if confirmed, will put resorcin in the front rank of 
remedies for malarial diseases. Indeed, it is highly probable that in 
one of the members of this group we will presently have a real rival 
and an equal to quinia. 

Resorcin has been used by Dujardin-Beaumetz, Andeer, and others, 
with great success locally in syphilitic and other sores of an unhealthy 
or sloughing character. Its solution may be applied as spray in affec- 
tions of the nose and throat, catarrhal, ulcerating, or specific. Andeer 
affirms that, applied in crystals or in powder, it is the most efficient 
remedy in diphtheritic affections. 

Hydroquinone and Pyrocatechin are members of the dihydroxyl- 
benzol group with resorcin, act similarly, and are, it is said, more effec- 
tive as antipyretic medicines, especially in the malarial fevers. They 
may be administered internally and applied topically in the same way 
that resorcin is now used. 

Authorities referred to : 

Andeer, Br. Julius. Pamphlet, Ueher Resorcin. Abstract in New Remedies, Sep- 
tember and October, 1880. 

Dujardin-Beaumetz. L 1 Union Med., April 2, 1881. On Resorcin for External Ap- 
plication. Quoted in London Medical Record, April 15, 1881. 

Lichtheim, Prof. Correspondcnzblalt far Schweizer Aerzie, July 15, 1S80. London 
Medical Record, October 15, 1880. 

Acidum Boracicum. — Boracic acid. Acide boracique, Fr.; Bor- 
sciitre, Ger. 

Properties. — Boracic acid occurs in glittering, white, scaly crystals. 
It is soluble in twenty-six parts of cold and in three parts of warm 
water, and is freely soluble in alcohol. 

Actions and Uses. — Boracic acid possesses decided antiseptic and 
deodorant properties. It arrests fermentations and putrefactive decom- 
position, and is destructive of minute organisms — bacteria, vibrio, etc. 
Applied to wounds, it is free from irritating effects; it lessens suppura- 
tion, and prevents decomposition. 

Boracic acid occupies an important place in Lister's antiseptic 
method. It appears to be as effective as carbolic acid, and is even less 
irritating to the tissues than salicylic acid. A saturated solution may 
be employed as a dressing to fresh wounds to prevent the action of 
atmospheric germs, or to arrest decomposition in gangrenous, sloughing, 
or ill-conditioned wounds. " Boracic lint " is made by steeping lint in 
a saturated solution of boracic acid at the boiling-point ; and, after 
drying, it is found to hold a large quantity of the acid, weighing nearly 
twice as much as before being thus treated. 

Mr. Lister's directions for the application of boracic-acid dressings 
to ideers are as follows : " The first step is to cleanse the sore and the 
surrounding skin once for all from septic impurity. This is done by 



BORACIC ACID. 543 

treating the surface of the sore freely with a solution of the chloride of 
zinc (forty grains to the ounce); and at the same time washing the in- 
tegument with a strong watery solution of carbolic acid, which is used 
on account of its remarkable power of penetrating the epidermis, while 
for the sore itself the solution of the chloride appears to be more effi- 
cient. This preliminary step having been taken, the boracic dressing 
is at once employed as follows : A piece of oiled-silk protective, of 
sufficient size to cover the sore and slightly overlap the surrounding 
skin, is dipped iu the boracic lotion (a saturated, watery solution) and 
applied, and over this a piece of boracic lint large enough to extend for 
an inch or more beyond the protective on all sides, the whole being re- 
tained in position with a bandage." 

Mr. Lister has used boracic solutions with great success in pru- 
ritus ani, ulcers, skin-grafting, herns and scalds, eczema, in opera- 
tions on the penis, etc. By Mr. Watson, these solutions have been 
employed with excellent results in the dermatophyta ; for example, 
tinea tonsurans and t. circinata — especially "in that very trouble- 
some form of the disease which affects the scrotum and inner side of 
the thighs." 

Boracic ointment may be made as follows : " Take of boracic acid 
finely levigated one part ; white wax, one part ; paraffine, two parts ; 
almond-oil, two parts. Melt the wax and paraffine by heating them 
with the oil, and stir the mixture briskly along with the boracic-acid 
powder in a warm mortar until the mixture thickens." When required 
for use, this ointment should be rubbed up with a little glycerine to 
the proper consistence, and then spread on muslin or linen. 

Boracic acid may be employed in all the various forms and combi- 
nations in which carbolic and salicylic acids are now used by the anti- 
septic method. 

Borocitrate of magnesia, originally proposed by Becker, has been 
recently strongly urged by Madsen as a solvent of urinary calculi of 
the uric-acid variety. It may be extemporaneously prepared as 
follows: R. Magnesii carbonat., 3j ; acid, citric, 3 ij ; sodii bibo- 
rat., 3 ij ; aquas bul., 5 viij. M. Sig. A tablespoonful three or four 
times a day. 

Tartraborate of potassium is, probably, a more generally useful 
remedy for the purpose above indicated, as the potash compounds of 
uric acid are more soluble than the soda compounds. As a solvent of 
uric-acid calculi, this salt is preferable. It is obtained by heating to- 
gether four parts of cream of tartar, one part of boracic acid, and ten 
parts of water. It is a white powder, or occurs in transparent scales, 
has an acidulous taste, and dissolves in two parts of cold water. A 
scruple may be given three or four times a day in water, and the 
more largely diluted it is, the better when used for the solution of 
calculi. 



544 ANTISEPTICS. 

Authorities referred to : 

Husemann, Dr. Theodor. Handbuch des gcsammlen Arzncimiliellchre, erster Band, 
p. 284. 

Lister, Prof. Joseph. On Recent Improvements in the Details of Antiseptic Surgery. 
The Lancet, vol. i., 1875. 

Watson, Dr. Indian Medical Gazette. The Lancet, vol. ii., 1875, p. 750. 

Benzoinum. — Benzoin. A solid balsam obtained from styrax ben- 
zoin. Benjoin, Fr. ; Benzoeharz, Ger. 

Composition. — Benzoin is made up of resins. When subjected to 
dry distillation it yields benzoic acid, which is contained in it in the 
proportion of fourteen to eighteen per cent. Certain varieties of ben- 
zoin contain, also, cinnamic acid. 

Tinctura Benzoini, — Tincture of benzoin ( 3 vj — Oj). Dose, 3 ss 

-3j. 

TTnguentum Benzoini. — Ointment of benzoin. (Tincture, 3 i j ; 
lard, !xvj.) 

Tinctura Benzoini Composita. — Compound tincture of benzoin. 
(Benzoin, socotrine aloes, storax, balsam of tolu, alcohol.) Dose, 3 ss 
— 3 ij. 

Acidum Benzoicum. — Benzoic acid. "Is in white, feathery crys- 
tals, of a peculiar, agreeable odor, and warm, acidulous taste, sparing- 
ly soluble in cold water, more soluble in boiling water, which deposits 
it in part on cooling, and very soluble in alcohol." 

Ammonii Bcnzoas. — Benzoate of ammonia. "Is in minute, white, 
shining, thin, four-sided, laminar crystals, with a slight odor of officinal 
benzoic acid, and a bitterish, saline, somewhat balsamic taste, and 
slightly acrid but persistent after-taste. It is soluble in water and 
alcohol." Dose, grs. v — 3 ss. 

Actions and Uses. — The physiological effects of benzoin and its 
preparations are due to benzoic acid. Taken in vexy considerable 
doses ( 3 ss) benzoic acid produces some epigastric heat, increases the 
pulse-rate, and promotes bronchial and cutaneous transpiration. The 
acidity of the urine is rendered more decided by it. A large part of 
the acid is excreted by the kidneys as benzoic acid, and a part under- 
goes conversion into hippuric acid. ' 

Recent observations have shown that benzoic acid has decided an- 
tiseptic properties (Salkowski). It manifests the same jjower to pre- 
vent fermentations and putrefaction, and to destroy minute organisms, 
possessed by salicylic and boracic acids. 

The tinctures of benzoin were formerly used as expectorants in 
chronic bronchial affections. They are now sometimes resorted to for 
the local treatment (by atomization) of chronic laryngeal affections. 
Their most important use, however, is in the treatment of foul-smelling 
wounds, flabby granulations, etc. Unhealthy or sloughing wounds 



DENZOATES. 545 

may be dressed with linen or cotton cloths saturated with the tinctures, 
with the effect to destroy fetor and stimulate to a more healthy growth. 
Chapped /ninth and lips and fissured 'nipples are best treated, accord- 
ing to Stille, with a mixture of compound tincture of benzoin and 
glycerine. Benzoic acid may be used as a substitute for boracic and 
salicylic acids, in the antiseptic treatment of wounds. Its solubility in 
water can be increased by the addition of borax. 

Benzoate of ammonia is a remedy of great utility when the urine is 
ammoniacal and loaded with phosphates. Under its use the urine be- 
comes acid; and the fermentative changes are arrested. In chronic 
cystitis, arising from any cause, this remedy should be prescribed when 
the urine undergoes the alkaline fermentation. Incontinence of urine, 
when due to an alkaline reaction of this excretion, is cured by the ben- 
zoate of ammonia. Phosphatic calculi may be dissolved by the long- 
continued use of this remedy. 

Bexzoate op Sodium has lately occupied a large place in profes- 
sional attention. Having similar antiseptic and antipyretic properties 
to those of salicylate of sodium, and being without any injurious effect, 
it came to be largely used in the septic maladies. The first important 
observations were those of Dr. Klebs, of Prague, who announced that 
this salt can be used with good effects in all infectious febrile diseases; 
that while the febrile movement does not cease as quickly as after the 
use. of sulphate of quinia and salicylate of sodium, the results obtained 
from the benzoate are more permanent. Moreover, absolutely no un- 
pleasant after-effects were observed from this remedy, even when its 
use was much prolonged, and as much as three hundred and eighty 
grains daily could be taken without inconvenience. The usual daily 
quantity required in the treatment of diseases is ten to fifteen grammes, 
or one hundred and fifty to one hundred and eighty grains. Dr. 
Klebs advised the use of benzoate of soda in the acute infectious dis- 
eases in tuberculosis, and catarrh of the bronchi. The principle under- 
lying these suggestions of Dr. Klebs is the antiseptic. He holds that 
the maladies in question are of parasitic origin. The appropriate 
remedy is an antiseptic, destructive of germs. There are several 
remedies having these powers, but benzoate of sodium is' best, because, 
while very destructive of minute organisms, it is free from injurious 
effects on the body. A remarkable and sudden extension was given 
to the use of this salt by the report from Innspruck, that cases of con- 
sumption far advanced w r ere being quickly cured, in the clinic of 
Prof. Propop Rokitansky. Subsequent investigations proved the in- 
accuracy of such observations. Klebs held that he had proved the 
parasitic origin of phthisis, and Prof. Schiiller, of Greifswald, con- 
firmed his statements by additional experiments. It was discovered in 
Klebs's laboratory that, if animals were made to inhale the spray of 
benzoate of sodium, tubercular and diphtheritic matter did not affect 
36 



546 ANTISEPTICS. 

them. Then followed the treatment of cases of consumption, by spray 
of a solution of the benzoate. Although the first claims put forth 
were greatly exaggerated — not entirely unfounded — there is reason to 
believe that the free use of benzoate spray is of service in some cases 
of consumption. According to the estimate of Rokitansky (Propop), 
the patient must inhale -j-gVo tn °^ tne body- weight daily of the ben- 
zoate in the form of spray, to do any good. Among the numerous 
observations in opposition to the views of Klebs and his followers, may 
be selected those of Guttmann, who found that the treatment did not 
relieve a single symptom, and that there was no appearance in the 
affected lungs of any attempt at reparation. 

Benzoate of sodium has been used in other infectious diseases. 
Thus Letzerich has employed it with success in the treatment of diph- 
theria. Of twenty-seven cases treated with this remedy in one epi- 
demic, only one proved fatal, and this was an infant of feeble consti- 
tution. He gave from five to twenty grammes daily (seventy-five to 
three hundred grains), according to age, and applied the powdered 
benzoate by insufflation to the diseased parts. Other physicians have 
not been so largely successful, but many very favorable reports have 
been published (Kien, Hoffmann). Thus Demme found it highly 
serviceable in diphtheria and scarlet fever. It is well established that 
benzoate of sodium, added to the diphtheritic fungus, renders it harm- 
less, so that the local use is founded on sound reasons. As an anti- 
pyretic in the eruptive fevers, in typhoid,, and in malarial fevers, this 
salt may be preferred to the salicylate, than which it is safer, although 
much less effective as an antipyretic. In acute rheumatism it has been 
administered by Senator, McEwan, and others, who have found it a 
good and safe remedy, but not so active as salicylic acid. Tordens 
has treated whooping-cough successfully, using the prescription of 
Letzerich : $ . Sodii benzoat., 3 iv ; aquae destil., aquse menth. pip., 
aa 3 x ; syrup, aurantii, 3 ij. M. Sig. Two drachms every hour or 
two. 

Authorities referred to : 

Demme, Dr. Allg. Wiener med. Zeitung, No. 24, 1880. 
Guttmann, Dr. Paul. Berliner Jclin. Wochen., December 8, 1879. 
Klebs, Dr. Allg. med. Centrakeitung, June 5, 1878. 
Kohler und Dittel. Berl. Jelin. Woch., No. 44, 1879. 
Letzerich, Dr. Berliner hlinisehe Wochen., No. 1, 1879. 
McEwan, Dr. David. British Medical Journal, March, 1881, p. 336. 
Salkowski, Dr. E. Yirchoio's Archiv, Band lxsviii., p. 30. 
Senator, Dr. Zeilschrift fur Hinische Med., Band i., p. 41. 

Tordens, Dr. Edouard. Jour, de Med. dc Brux., May, 1880. London Med. Bccord, 
August 15, 1S80. 

Antiseptic Oils. — Oleum Caryophylli. Oil of cloves. 
Composition. — Oil of cloves consists of two substances — a hydro- 



ANTISEPTIC OILS. 547 

carbon, light oil of dorrs, and an oxygenated oil — eugenol', which has 
acid properties, and is therefore called eugenic acid. The light oil of 
cloves is isomeric with the oils of turpentine, copaiba, and cubebs. 

Salicylic acid and a camjdior known as caryopliylliii are also con- 
stituents of the oil of cloves. Dose, gtt. ij — gtt. v. 

Oleum Gaulthcrice. — Oil of gaultheria. 

Composition. — Oil of gaultheria contains a hydro-carbon — gatdthe- 
rilen, and an acid — methy salicylic acid — to which the acid reaction of 
the oil is due. Dose, gtt. v — gtt. xx. 

Oleum Thymi. — Oil of thyme. "The volatile oil obtained from 
thymus vulgaris." 

Composition. — Oil of thyme contains a hydro-carbon which, by 
fractional distillation, is resolvable into cymene and thymene. Its most 
important constituent is a solid crystalline substance, having acid prop- 
erties and homologous with carbolic acid. This is known as thymol, or 
thymic acid. Dose, gtt. ij — gtt. x. 

Oleum Cajuputi. — Oil of cajeput. " The volatile oil obtained from 
the leaves of melaleuca cajuputi." Dose, gtt. v — gtt. xx. 

Composition. — The most important constituent of the oil of cajeput 
is cajuputol, or the bihydrate of cajuputene. 

To this list might be added eucalyptol, the camphor obtained from 
eucalyptus globulus, and the various balsams, and cymene and tcrpene 
volatile oils ; but these remedies have already been considered else- 
where, so far as they possess any practical importance. 

Physiological Actions. — The composition of this group of oils 
indicates the close correspondence between them and carbolic, salicylic, 
and benzoic acids. So intimate are the chemical relations of salicylic 
acid, benzoic and cinnamic acids, that the balsams might with propriety 
be grouped with the antiseptics, for in their physiological actions and 
therapeutical applications they are equally as closely related as in their 
elementary composition. 

Of the members of this group, thymol or thymic acid has been most 
elaborately studied. Lewin has shown that thymol, as respects its in- 
fluence on fermentation and putrefaction, has a positive antiseptic prop- 
erty. Its actions are similar to those acids of the same class to which 
it is so closely allied chemically, viz., carbolic, salicylic, and benzoic. 
Locally applied, thymol, just as carbolic acid, produces paralysis of the 
end-organs of the sensory nerves (Lewin). 

The effects of thymol have also been studied by Balz. He has 
ascertained that from twenty to thirty grains a day are necessary to 
produce distinct effects. Placed in contact with the fauces, it causes 
an acrid sensation, which persists. It rarely excites vomiting, but a 
large dose induces a sensation of heat about the epigastrium, and 
sometimes diarrhoea. In the majority of cases thymol causes, in about 
half an hour to an hour, sweating more or less profuse, but distinctly 



548 ANTISEPTICS. 

less than that produced by salicylic acid and jaborandi. The urinary 
secretion is sometimes increased. The urine presents a dark, greenish 
hue, as if it contained blood. Singing in the ears, deafness, and a sen- 
sation of constriction of the forehead, are among the nervous phe- 
nomena. The researches of Lewin and Balz place thymol in the same 
category with eucalyptol, salicin, salicylic acid, resorcin, and carbolic 
acid. 

Myetol. — This new antiseptic has the same relative origin as thy- 
mol ; it is derived from the myrtle and is an oil, isomeric with the oil 
of turpentine (?). It is a very active antiseptic (Gubler). It prevents 
the decomj)osition of urine and other putrescible animal substances, 
and has been used to destroy the fetor of decomposing pus. As an 
active parasiticide it has been used successfully against the round 
worm, and the ascarides infesting the rectum. By Laboulbene it has 
been prescribed for the expulsion of taenia, with only partial success. 
The parasitic affections of the skin, favus, herpes, and pityriasis, are 
cured by myrtol. 

In moderate doses this agent is rather grateful to the stomach, and 
is a stomachic tonic or stimulant. The most important application 
made of it is in the treatment of bronchorrhcea, fetid bronchitis, gan- 
grene of the lung, etc. Eliminated by the lungs largely, it stimulates 
the tissues through which it passes, and thus a local action is added to 
the systemic effect. Chronic bronchitis, capillary bronchitis, whooping- 
cough, humid asthma, etc., are maladies in which it may be expected 
to afford a large measure of relief. In hematuria not due to acute 
congestion, and in p> a ssive hcemorrhages in general, it has been used 
with success. 

It has long been known that oil of cloves, and indeed the essential 
oils generally, have the power to relieve a painful state of a sensory 
nerve. Inserted into the cavity of an aching tooth, they suspend the 
pain. A solution of oil of cloves in rhigolene is a nostrum for the 
cure of superficial neuralgice. R,. 01. caryophylli, ol. gaultherise, ol. 
thymii, aa. 3 j ; tinct. benzoini, tinct. cinnamomi, aa, 3 iv. M. S. Ap- 
p>ly on lint, and cover with oiled silk. 

The oil of cloves is the most effective deodorizer for sponge-tents 
hitherto employed. 

The essential oils dissolved in alcohol (essence or tincture) are 
much used to correct flatulence. 

Cajeput-oil has been used . successfully in cholera, cholera-morbus, 
and nervous vomiting. IJ. 01. cajuputi, 3 j ; spts. chloroform!, tinct. 
cinnamomi, aa § j. M. S. A teaspoonful every half-hour in glycerine 
or sirup and water. As a parasiticide, cajeput-oil is an effective local 
application in parasitic skin-diseases — scabies, tinea, 2^>ityriasis, etc., 
and in the form of enema, in a suitable vehicle, against asca?'ides ver- 
micular es. 






EMETICS BY LOCAL ACTION. 549 



REMEDIES USED TO CAUSE SOME EVACUATION 
FROM THE BODY.— EVACU ANTS. 

EMETICS. 

Some of the agents in this group produce vomiting by virtue of a 
local action on the stomach, and do not affect this viscus when intro- 
duced elsewhere. These may be entitled, Emetics by Local Action. 
There are others which cause emesis, when they enter the blood at any 
point — Systemic Emetics. The first sub-group of emetics make an im- 
pression on the gastric nerves, and an action is at once instituted for 
their expulsion. The process consists in the transmission of the periph- 
eral irritation to the spinal centre, the generation of a motor impulse, 
and the consequent action of the nervous and muscular apparatus con- 
cerned in the the mechanism of vomiting. The systemic emetics pro- 
duce their effects through the intermediation of the blood, and the vom- 
iting is only one of the results of the disturbance introduced into the 
functions of the nervous system. 

EMETICS BY LOCAL ACTION. 

The most important of these are : 

Cupri sulphas, sulphate of copper. 

Zinci sulphas, sulphate of zinc. 

Hydrargyri sulphas flava, yellow subsulphate of mercury. 

Alumen, alum. 

Sinapis, mustard. 

Scilla, squill. 

All of the members of this group have been discussed in other parts 
of this work, except mustard and squill, and the consideration of these 
will be more appropriate elsewhere. It is necessary, however, in this 
place to indicate the nature of the action, the cases to which they are 
adapted, and the mode of administration of the more important of the 
emetics belonging to this division. 

Cupri Sulphas. — This is a very prompt and efficient emetic. The 
action begins in a few minutes, and the medicine comes up with the 
vomited matters. Very little depression follows the emetic effect. It 
is more especially adapted to the treatment of narcotic poisoning, be- 
cause, the action being local, the obtunded state of the reflex centres 
interferes less with its operation than is the case with the systemic- 
emetics. It is also occasionally used in croup, to effect the dislodgment 
of the false membrane, but other mechanical emetics are preferable. 

Administration. — Dissolve twenty grains of the sulphate of copper 
in two ounces of distilled water, and give a tablespoonful every fifteen 



550 EVACUAKTS. 

minutes until vomiting occurs. When prompt action is required, as in 
narcotic poisoning, ten grains of the sulphate of copper may be given 
at a draught in an ounce or two of water. Its action should be assisted 
by the free use of diluents. 

Zinci Sutyhas. — This agent acts in a manner similar to the corre- 
sponding copper-salt, but is less powerful It has the advantage of be- 
ing less likely to induce gastro-enteritis than sulphate of copper, and is, 
therefore, usually preferred to the latter. It is administered in cases of 
narcotic poisoning, in croup, and to relieve the stomach of indigestible 
alimentary substances. 

Administration. — In narcotic poisoning a scruple of the sulphate 
of zinc may be administered in water, and, if need be, repeated once. 
In croup, or for other purposes, as an emetic, it may be given as fol- 
lows : Dissolve a half-drachm in two ounces of water, and administer a 
tablespoonful every fifteen minutes until emesis is produced. The free 
use of diluents promotes the emetic action. 

Sydrargyri Sutyhas Flava. — This is one of the most efficient mem- 
bers of this group. It is an active poison, but, as it is returned with the 
contents of the stomach, no danger attends its administration. It does 
not act so speedily as copper and zinc. It produces very little nausea, 
but, when the action begins, the effects are suddenly experienced, and 
are powerful, without leaving after-depression and sickness. It is not 
so well adapted to the treatment of narcotic poisoning as the copper 
and zinc sulphates, but it is the most desirable emetic in the treatment 
of croup. It was formerly mucli prescribed in this disease as an emetic, 
but it fell out of fashion until revived recently by Dr. Fordyce Barker. 
The author's experience in its use is quite in accord with the much 
more extended experience of Dr. Barker. 

Administration. — As the yellow subsulphate of mercury has but 
little taste, it is easily administered to children. It should be prescribed 
in the form of powder, rubbed up with sugar of milk. The dose varies 
from three to five grains. Dr. Barker makes the useful suggestion that 
powders of this preparation, labeled " croup-powders," should be kept in 
every household, the children of which have the tendency to attacks of 
croup. It should be given when the first symptoms manifest them- 
selves, and its repetition will be governed by the state of the breath- 
ing. 

Alumen. — Powdered alum is a safe, efficient, but slow emetic. 
About a half-hour usually elapses after it is swallowed before the eme- 
sis occurs. It acts mechanically, produces no considerable nausea, and 
leaves behind no depression. As an emetic its only use is in croup and 
diphtheria, administered with the view to cause a detachment of the 
false membrane. Some effect has been ascribed to the local action of 
the alum in its passage along the throat, but this opinion is scarcely 
tenable. 



SYSTEMIC EMETICS. 55J 

Administration. — A teaspoonful of powdered alum may be admin- 
istered in sirup, honey, or mucilage. It can be repeated, it* need be, 
every half-hour. 

/Si?iaj)is. — Mustard is a stimulant, local emetic. It acts promptly 
and efficiently. In emergencies, other emetics not being available, it 
may be employed in narcotic and other forms of poisoning. As an 
emetic it is especialty adapted to depressed conditions of the system — 
for, -while it causes vomiting, it stimulates the action of the heart. 
When, therefore, an emetic is indicated, and at the same time the cir- 
culation is feeble, the surface cold, and the functions of animal life op- 
pressed, mustard should be used. 

Administration. — A tea to a dessert spoonful of powdered mustard 
should be stirred up in a tumblerful of tepid water, and quickly swal- 
lowed. The irritant action of the mustard may be limited, and its 
emetic action promoted, by the free use of diluents. 

Scitta. — Squill is never employed as an emetic by and of itself. It 
is harsh and rather slow in action. In the form of the compound sirup 
of squills, it is not unfrequently used for this purpose, especially in 
domestic practice, but the emetic property of this combination is due 
chiefly to the tartar-emetic which it contains. 

SYSTEMIC EMETICS. 

Apomorphia. — An alkaloidal substance obtained by the action of 
strong acids from morphia contained in closed tubes and subjected to a 
somewhat elevated temperature. It is obtained also by the action of 
chloride of zinc in solution on morphia. If is a whitish powder, which 
becomes greenish by absorption of moisture. It is soluble in water, 
and it may, therefore, be administered in this menstruum. Dose, gr. 
■fa to gr. -J. If given bypodermatically, gr. fa is sufficient ; if by the stom- 
ach, gr. £. As it undergoes important changes when in contact with 
water, the solution for hypodermatic use should be made when required. 

Physiological Actions. — Whether injected under the skin or taken 
into the stomach, apomorphia causes vomiting. The rate at which it 
moves to affect the stomach depends somewhat on the dose administered. 
From five to twenty minutes usually elapse after the hypodermatic in- 
jection before vomiting begins. The act of vomiting is preceded by 
very little nausea, the contents of the stomach are usually thoroughly 
evacuated, and the vomiting recurs a few times at intervals of a quarter 
to a half hour. In young subjects very considerable depression has been 
observed to be produced by it, and dangerous symptoms of cardiac pa- 
ralysis have followed its emetic action in a few instances. These clinical 
facts seem to contradict the experimental observations of Siebert and 
Moerz, who have shown that apomorphia does not affect the blood-press- 
ure, and that the pulse rises when emesis comes on, reaches its maxi- 
mum during vomiting, and declines in the interval. The cardiac depres- 



552 EVACUANTS. 

sion vvliich has been observed, clinically, may have been the result of 
idiosyncrasy, yet we should not lose sight of the fact observed by Har- 
nack, that in cold-blooded animals it may be produced experimentally. 

Apomorphia causes at first increased rapidity of the respiration, af- 
terward diminishes the force and depth of the movements, and finally 
arrests them. As this result occurs when the vagi are divided, the 
drag must necessarily first excite and afterward exhaust the irritability 
of the respiratory centre. Apomorphia has no appreciable influence on 
the temperature. 

As respects its influence on the nervous system, apomorphia is at 
first strongly excitant. Afterward it causes muscular tremblings, fol- 
lowed by paralysis and convulsions. The muscular irritability is im- 
paired but not destroyed, and the functions of motor and sensory nerves 
remain intact ; hence it may be concluded that the convulsant action of 
this agent is due to a direct impression on the spinal cord (the spasm- 
centre). 

Therapy. — Apomorphia is indicated as an emetic when swallowing 
is difficult or impossible, and when very prompt action is necessary. 
As it produces vomiting by its spinal action, profound narcosis will pre- 
vent it, and hence, in narcotic poisoning , it may fail of effect unless ad- 
ministered before narcosis has supervened. It is a suitable emetic when 
it is desired to empty promptly an overloaded stomach. It is to be 
preferred to all emetics which must be introduced into the stomach, 
when this viscus is in a state of inflammation, for it is best given subcu- 
taneously. Apomorphia has been administered as an emetic in suffoca- 
tive catarrh, to empty mechanically the bronchial tubes, but it produced 
serious depression — a result which might have been a priori predicted, 
since this drug exerts a paralyzing action on the respiratory organs. 
It has also been given as an expectorant, but on insufficient data, for 
it does not seem to have an effect upon the vagi, and, as above stated, 
at first it excites the respiration movements, and afterward paralyzes 
them. 

As compared with its congeners, morphia and codia, it is more exci- 
tant than morphia and codia, and without their hypnotic and anodyne 
properties. As respects its convulsant action in animals, it has close 
physiological relations to narcotina and thebaia. Some clinical experi- 
ences have shown (Riegel u. Bohm) that apomorphia causes heaviness 
in the head, giddiness, drowsiness, yawning, mental hebetude, etc. The 
trials in which these results were noted were made with Merck's prep- 
aration of apomorphia. 

Authorities referred to : 

Gee, Dr. Samuel. Note upon Apomorphia and Chlorocodide. St. Bartholomew's Ebi. 
pital Reports, vol. v., 1869. 

Harnack, Dr. E. Arch. f. experimentelle Pathologic und Pharmacologic, voL iL, 
p. 291. 



SYSTEMIC EMETICS. 553 

Hermann, Dr. L. Lehrbuch der experimmtellen Toxicologic, p. 381. 

Heosemann, Dr. Tiieod. Handbuch, etc., zweiter BaDd, p. 615. 

Moerz, Dr. A. I'rag. Vjhrsbr., 70, 1872. Abstracted in Schmidt's Jahrbitcher, voL 
clvii., p. 12. 

Queiil, Dr. Max. Weber die phys. Wirkungen des Apomorphia. Schmidt's Jo.hr- 
likher, vol. civ., p. 14, et seq. 

Riegel und Boiim. Arch. f. kiln. Med., vol. ix., 2, p. 211, 1871. 

Siebert, Dr. Vincent. Untcrsuchungen Tiber die physiol. Wirkungen des Apomor- 
phin. Abstracted in Schmidt's Jahrbiichcr, vol. civ., p. 14, et seq. 



Ipecacuanha. — Ipecacuanha. The root of cephaelis ipecacuanha. 
Racine a"' ipecacuanha, Fr. ; Brechicurzel, Ger. 

Extractum Ipecacuanha} Fluidum. — Fluid extract of ipecacuanha. 
Dose, m. ij — 3 j. 

Syrupus Ipecacuanha. — Sirup of ipecacuanha (fluid extract, 3 ij ; 
sirup, 3 xxx). Dose, 3 j — 3 ss. 

Trochisci Ipecacuanhas. — Troches of ipecacuanha (ipecac, traga- 
canth, arrow-root, sugar, and sirup of orange-peel). Dose, one or more. 
Each troche contains one-fourth of a grain of ipecacuanha. 

Trochisci Morphias et Ipecacuanhas. — Troches of morphia and ipe- 
cacuanha (each troche contains one-fortieth of a grain of morphia, and 
one-twelfth of a grain of ipecac). 

Vinum Ipecacuanha?. — Wine of ipecacuanha (fluid extract of ipe- 
cac, § ij ; sherry wine, 3* xxx). Dose, in. i — 3 j. 

Pulvis Ipecacuanhas Compositus. — Compound powder of ipecacu- 
anha. Dover's powder. Ten grains contain one grain each of ipecac, 
and opium, and eight grains of potassium sulphate. This preparation 
has already been discussed in the article on opium, and requires no con- 
sideration here. 

Composition. — Ipecacuanha contains an active principle, designated 
emetia or emetine. This exists in the bark of the root, in combination 
with a peculiar acid — ipecacuanhic acid. The alkaloid is found in the 
root in a proportion somewhat less than one per cent. It is a bitter, in- 
odorous, and amorphous substance, colorless, and alkaline in reaction. 
It is freely soluble in chloroform and only slightly so in ether. Ipecac- 
uanhic acid is a glucoside, and is chemically related to kinic and caffe- 
tannic acids. 

Antagonists and Incompatibles. — The salts of lead and mercur}', 
the vegetable acids and astringent infusions, are incompatible. The 
tannate of emetia is extremely insoluble. Bismuth, carbolic acid, hy- 
drocyanic acid, and narcotics generally, hinder its emetic action. 

Synergists. — The emetics — those by local action and the systemic — 
favor the vomitive action of ipecac. Its effects on the skin and bron- 
chial mucous membrane are promoted by opium, warm diluents, etc. 

Physiological Actions. — Inunctions of ipecacuanha excite very 
considerable irritation of the skin : at first, small isolated pustules ap- 



554 EVACUANTS. 

pear, and these are followed by large pustules and ulceration (Duck- 
worth). When applied to the mucous membrane of the nares, it pro- 
duces a sensation of heat and causes sneezing. Some persons are so 
susceptible to its action that the smallest quantity inhaled will induce 
an asthmatic paroxysm. 

Administered by the stomach in small doses (from one-eighth to 
one-quarter of a grain), ipecacuanha acts as a stomachic tonic, and 
probably increases the gastric secretions. In larger doses (from five 
grains to a scruple), it is nauseant and emetic ; but the sickness which 
it causes is not severe, and the vomiting is not accompanied nor fol- 
lowed by much depression. Its action as an emetic is rather slow, from 
twenty minutes to a half -hour being required, and is not persistent. 
Repetition of large doses will, in most cases, but not invariably, pro- 
duce a condition of tolerance, when vomiting does not occur, but a ca- 
thartic action is induced, the stools having a peculiar bilious character, 
appropriately designated "ipecacuanha-stools." Both vomiting and 
purging are sometimes produced by an emetic of ipecacuanha. 

Like other nauseants and emetics, ipecac, increases the secretions of 
the broncho-pulmonary mucous membraue, and is therefore held to pos- 
sess expectorant properties. More than any other agent of the class, 
it relaxes the skin, and promotes cutaneous transpiration. 

Ipecacuanha exerts but little influence over the circulation. In 
animals, lethal doses of emetia cause death by paralysis of the muscles 
of respiration, the heart continuing in action after the cessation of the 
respiratory movements (D'Ornellas). The temperature of the surface 
falls, but the internal temperature remains the same, or rises somewhat, 
owing, it is said (D'Ornellas), to the irritant action of the agent on 
the intestinal mucous membrane. 

In the post-mortem examination of animals killed by emetia, very 
considerable gastro-intestinal irritation is found. The lungs are some- 
times seen to be hyperasmic and presenting patches of hepatization, and 
sometimes exsanguine, but the former condition is more frequently ob- 
served. As the most common state of the lungs, caused by lethal doses 
of ipecac, is similar to that which is induced by section of the vagi, it is 
a reasonable conjecture that it has a special action on these nerves — 
according to Chouppe, on the terminal filaments of the vagi. The elimi- 
nation of emetia takes place in large part by the gastro-intestinal 
mucous membrane, and is found in the secretions. 

Therapy. — For ordinary purposes no emetic is more safe and effi- 
cient than ipecacuanha. As it causes but little depression, and is free 
from irritant effects in ordinary doses, it may be given in conditions of 
the system in which tartar-emetic and the other mineral emetics are 
inadmissible. When the stomach is to be relieved of indigested ali- 
ment, ipecacuanha is the most suitable emetic. Attacks of acute in- 
digestion, migraine, and the so-called bilious sick-headache, may not 



SYSTEMIC EMETICS. 553 

unl'requently be cut short by an ipecac-vomit. The good effects of llie 
vomitive treatment are, not unfrequently, most strikingly exhibited in 
the beginning of continued fevers, the eruptive fevers, erysipelas, and 
periodical fevers. It has been alleged that fevers are sometimes 
" aborted " in this way. In denying the possibility of such results, it 
must be admitted that clinical experience has shown the good effects 
of the practice on the subsequent course of the malady. Formerly an 
ipecacuanha-emetic was much more frequently employed at the outset 
of fevers than is the fashion at present, and the author is convinced that 
this mode of treatment should be resorted to now in suitable cases. 
The indications for the use of emetic doses of ipecacuanha, in the fevers 
above-named, are these : a heavily-coated tongue, much nausea and in- 
effectual efforts to vomit, a strong sense of epigastric oppression, icterus 
or an icterode hue of the surface, a hot and dry skin, acid and turbid 
urine. When these symptoms are present in cases of malarial fever, 
the antiperiodic remedies will be much more effective in their action 
if their administration has been preceded by an ipecacuanha-emetic. 

In all the cases in which emetics are employed for mechanical effects, 
as in membranous croup, capillary bronchitis, foreign bodies lodged, 
etc., ipecacuanha may be used. In croup it is not so effective as the 
yellow subsulphate of mercury ; in capillary bronchitis, as tartar-emetic ; 
but, as respects the latter disease, ipecacuanha is to be preferred in the 
very young or very old, and in those debilitated by any cause. In the 
domestic treatment of laryngismus stridulus an emetic dose of the 
sirup of ipecac, is the most usual remedy. 

As an emetic twenty grains of the powder of ipecacuanha may be 
diffused in a cup of warm water, and a tablespoonful of the mixture 
exhibited every fifteen minutes until emesis occurs. Two grains may 
cause vomiting, and four grains will usually act efficiently ; hence a 
good method of proceeding, when an emetic effect is desired, is to ex- 
hibit a powder of four grains in a tablespoonful of warm water every 
fifteen minutes until vomiting occurs. The action will be facilitated 
by drinking freely of warm water ; but, if the systemic impression of 
the ipecacuanha is desired, the patient should retain the recumbent post- 
ure, and all fluids should be withheld. If the cathartic as well as the 
emetic action is sought for, some weak animal broth should be given 
when the stomach is emptied of its contents. If free action of the skin 
is to be promoted, as soon as the vomiting has ceased warm aromatic 
infusions should be administered, and the patient should be covered 
with blankets. 

It has long been known that ipecacuanha, in small doses, has the 
power to arrest certain kinds of vomiting. Attention has recently been 
recalled to this curious fact. It is in nervous vomiting more especially 
that this remedy is useful: for example, in the vomiting of pregnancy, 
vomiting of drunkards, vomiting of migraine, etc. A minim of the 



55G EVACUANTS. 

vinum ipecacuanhas, given every half-hour or hour in a little water, will 
sometimes relieve these cases in a very remarkable manner; but it very 
frequently fails, and there are no indications at present known which 
will enable the practitioner to determine beforehand whether it will or 
will not be successful. 

It is a singular fact, showing the remarkable phases through which 
professional opinion passes, that ipecacuanha, which was introduced at 
the close of the seventeenth century as a remedy for dysentery, after a 
time ceased to be employed in this disease, but has again been restored 
to the estimation in which it was originally held. Epidemic dysentery, 
especially of malarious and tropical countries, is the form of the disease 
to the cure of which ipecacuanha seems best adapted. The author has 
used it with much success in acute dysentery, as it occurs in the interior 
valley of this continent. When the characteristic ipecacuanha-stools 
are produced the tormina and tenesmus cease, and the dejections soon 
become feculent; the skin, previously dry and hot, becomes moist and 
cool, and a refreshing calm is experienced. Large doses of ipecacuanha 
are required in the treatment of acute dysentery. In the severe attacks 
of tropical regions, from twenty to sixty grains are given for the initial 
dose, and the quantity subsequently administered depends on the effect 
— usually about twenty grains every four, six, or eight hours. It is im- 
portant to establish tolerance of the remedy as speedily as possible. If 
the first dose be rejected, subsequent ones may be retained; Various 
expedients may be resorted to in order to secure the retention of these 
large doses. The ipecacuanha may be combined with some opium and 
aromatic powder: ]J. Ipecacuanhse, 3ss; opium, gr.j; pulv. aromat., 
grs. v. M. ft. pulv. no. j. After the dose of ipecacuanha is adminis- 
tered a sinapism may be applied to the epigastrium, and an enema of 
laudanum and starch, or the subcutaneous injection of morphia, may be 
practised. Milk is an excellent vehicle for the administration of ipe- 
cacuanha. In the cases of dysentery treated on this plan by the author, 
he has found that doses of fifteen grains, given in milk, were generally 
pretty well borne. It not unfrequently happens, however, that toler- 
ance cannot be established, and the remedy must then be abandoned. 
Some patients so object to the nausea produced by it as to be reluctant 
to take it, and others, after one trial, decline to continue the treatment. 
Notwithstanding these drawbacks, it must be conceded that ipecacu- 
anha is a most valuable remedy in epidemic and sporadic dysentery. It 
has been shown that in India, before the introduction of this method of 
treatment, the mortality from dysentery was about 79.6 per one thou- 
sand of cases; but, since the use of ipecacuanha has been generalized, 
the mortality has fallen to 20.15 per one thousand of cases. 

Ipecacuanha has also been used with success in chronic dysentery, 
but, in the author's experience, it is by no means so beneficial as in the 
acute. It succeeds best in those cases which are the outgrowth of acute 



SYSTEMIC EMETICS. 557 

attacks, and in which the intestinal ulcerations arc not far advanced. 
The rules for its administration are the same in chronic as in acute dys- 
entery. In the summer dysentery and diarrhoea of teething children 
ipecacuanha is often extremely serviceable. The special indication for 
its use is the occurrence of greenish stools, containing mucus and some- 
times blood. These stools are usually voided with much pain and 
straining. At the same time the skin is harsh and dry, the tongue 
rather dry and pasty, or glazed, and there is great thirst, although little 
or no fever may be present. Ipecacuanha changes the character of the 
stools, induces perspiration, and allays the thirst and dryness of the 
mouth. From two to five grains every two hours may be given in these 
cases, or it may be administered with pepsin, oxide of zinc, bismuth, or 
other remedies. I>. Ipecacuanhae, grs. xij; bismuthi subcarb., 3j; 
pepsinae sacch., 3 ss. M. ft. pulv. no. xij. Sig. One in milk every tico 
hours. 

The evidence is conclusive that ipecacuanha possesses very valuable 
antihaemorrhagic powers. It has been successful in hemoptysis, epis- 
taxis, menorrhagia, post-partum hemorrhage, etc. As Peter has ob- 
served, "the vomitive medication" (ipecacuanha) "arrests not only 
haemoptysis but all kinds of haemorrhage, and is, therefore, a general 
antihaemorrhagic medication." In haemorrhages the ipecacuanha should 
be given in frequently-repeated doses until vomiting ensues ; usually, 
when this effect is produced the haemorrhage ceases. Other antihaemor- 
rhagic agents may be combined with ipecacuanha. IJ. Ext. ipecac, 
fluidi, 3 ij ; ext. ergotae fluidi, 3 iv ; ext. digitalis fluidi, 3 ij. M. Sig. 
Thirty minims to a teaspoonfxd at a dose, as required. The author has 
witnessed excellent results from this combination in haemoptysis and 
menorrhagia. In the treatment of post-partum haemorrhage, the most 
suitable combination is fluid extract of ipecacuanha and fluid extract of 
ergot. Trousseau strongly urges the employment of ipecacuanha in 
post-partum haemorrhage, and, indeed, in the various accidents which 
occur in the puerperal state, among which he designates gastrointes- 
tinal irritation, suppression of the lochia, subacute metritis, pelvic cel- 
lulitis, bronchial catarrh, subacute pneumonia, etc. " He has not ob- 
served the. least ill-result from this practice ; on the contrary, in the 
most of these cases, he has obtained either a cure or a notable amend- 
ment " (Trousseau et Pidoux). 

Certain acute affections of the broncho-pulmonary mucous membrane 
are much benefited by non-emetic doses of ipecacuanha, for example, 
acute catarrh of the nascd and bronchial mucous membrane, hay- 
asthma, capillary bronchitis. An emetic dose will cut short an attack 
of laryngismus stridulus. An occasional emetic gives great relief in 
whooping-cough, when there is profuse bronchial secretion. Non- 
emetic doses of the fluid extract (m. j — m. iij) diminish the violence of 
the spasms in this disease. Nauseating and emetic doses are service- 



558 EVACUANTS. 

able in the attacks of spasmodic asthma, but the good effects of the 
remedy are loBt by repetition. Ordinary colds, especially in children, 
are benefited by doses sufficient to produce slight nausea but not vomit- 
ing. A troublesome cough at night, which prevents sleep, may not 
unfrequently be arrested by a dose at bed-hour of some one of the 
ipecacuanha preparations. For these various purposes the wine or the 
fluid extract may be used, but the latter preparation is much more 
trustworthy and effective than the former. 

Authorities referred to : 

Chouppe, M. Archives de Physiologic, No. 1, 1875, p. 101. 

D'Ornellas, Dr. Antonio-Evaristo. Du Vomissement, etc., Bulletin Gen. de Therap., 
vol. lxxxiv., pp. 193, 244, 295, 348. 

Duckworth, Dr. Dyce. St. Bartholomew' '« Hospital Reports, vol. v., p. 287, 1869 

Fluckiger and Hanbury. Pharmacographia, article Ipecacuanha. 

Fuller, C. C. London Lancet, December 4, 1869, On the Action of Ipecacuanha. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 608, et seq. 

Peter, M. Michel. Apropos des Hemoptysies et de leur Trailement par la Medication 
Vomitive, Bulletin Gen. Therap., vol. lxxvii. 

Phillips, Dr. C. D. F. On the Actions and Uses of Ipecacuanha, The Practitioner, 
vol. III., p. 276, et seq. 

Ibid. Materia Medica and Therapeutics, article Ipecacuanha. 

Ringer, Dr. Sydney. Handbook of Therapeutics. 

Trousseau et Pidoux. Traile de Therapeutique et Mat. Med., huitieme Edition, vol. 
i., p. 733, et seq. 

Alltimoilii et Potassii Tartras. — Tartrate of antimony and potassa. 
Tartar-emetic. 

This is a powerfully spoliative and depressing emetic, which has 
already been discussed under the head of " Agents promoting Destruc- 
tive Metamorphosis." It was formerly much employed as an emetic in 
croup, capillary bronchitis, and at the onset of fevers and inflamma- 
tions ; but the local irritation, as well as the systemic depression which 
follows its use, has led to its almost entire abandonment for these 
purposes. 

Admiitcstratton. — Six grains may be dissolved in four ounces of 
water, and a tablespoonful be given every fifteen minutes until emesis 
occurs. Ipecacuanha and tartar-emetic are frequently administered to- 
gether — twenty grains of the former and two grains of the latter. 

CATHARTICS. 

Purgatives are divisible into several groups, according to the nature 
of their action. 

Laxatives are medicines which stimulate the intestinal movements, 
without increasing to any considerable extent at least, the intestinal 
secretions. 



CATIIARTICS. 559 

Saline Purgatives excite increased secretion, while at the same 
time they hasten the peristaltic action. The dejections which are pro- 
duced by them are loose and watery. 

Mercurial Purgatives, chiefly calomel and blue mass, exert an influ- 
ence peculiar to themselves. "Without expressing an opinion at pres- 
ent, for or against their supposed cholagogue effects, the author believes 
that they differ so much in their action from other purgatives as to be 
appropriately placed in a separate class. 

Tonic-astringent and Resin-bearing Purgatives. — These affect the 
liver and the glandular appendages of the mucous membrane, and in- 
crease the tonicity of the muscular layer of the intestine. They increase 
the proper secretion of the glands, and do not merely cause an outward 
osmosis of fluid from the vessels. 

Hydragogue Purgatives act with great energy, and not only increase* 
the glandular secretions, but cause a very abundant outward osmotic 
flow, so that the dejections which they produce are extremely watery. 
This group of purgatives also excite very rapid and violent peristaltic 
movements. 

Laxatives. — Manna. — Manna. "The concrete saccharine exuda- 
tion, in flakes, of fraxinus ornus, and of fraxinus rotundifolia." Dose, 
3 j — | ij, according to age. 

Composition and Properties. — Manna has a sweetish, rather 
mawkish taste; is soluble, when pure, in three parts of cold water, and 
in its own weight of boiling water. It contains a sugar — manna-sugar, 
or mannite, which constitutes from seventy to eighty per cent, of the 
best specimens of manna. It is said to contain dextrine, or a mucilage 
having similar reactions, and ether extracts from it in small quantity a 
slightly acrid, reddish-brown resin, on which the laxative property of 
manna probably depends. 

Actions and Uses. — Manna is a very mild laxative, but, when 
administered alone, is apt to cause griping. It is rather slow in its 
operation, but is free from irritating qualities, and leaves no unpleasant 
after-effects. It is most frequently combined with other purgatives — 
senna chiefly — the operation of which it aids, and at the same time 
renders less drastic. It is rarely given alone, and only to children and 
pregnant women. Formerly it was used as a laxative in hemorrhoidal 
affections. 

Sidphur. — Sulphur lotum (washed sulphur). Sulphur sublimatum 
(sublimed sulphur). Washed sulphur should only be used as a laxative. 
Sublimed sulphur contains a trace of acid which imparts to it a griping 
quality. Dose, 3 j — 3 iij. 

Actions and Uses. — Sulphur is insoluble in water,'but dissolves in 
alkaline solutions and in the volatile and fixed oils. In the small intes- 
tine, sulphur is placed under favorable conditions for absorption. That 
it does enter the blood is proved by the fact that it appears in the per» 



560 EVACUANTS. 

spiration, urine, milk, etc. Silver coins, carried in the pockets of those 
taking sulphur, are discolored by the formation of the sulphide of sil- 
ver. Considerable sulphuretted hydrogen gas is produced as a result 
of the chemical changes in the intestines, and a quantity of offensive 
flatus is .an unpleasant sequel of its administration. The intestinal 
secretions are somewhat increased by it, and the stools are therefore 
softer. It is a very mild laxative. Combination of sulphur and bitar- 
trate of potassa or magnesia is occasionally resorted to, especially in 
domestic practice, for the purpose of increasing the laxative action. 

Sufficient attention has already been paid to the sulphur compounds, 
and it only now remains to speak of sulphur as a laxative. It is used 
chiefly to render the stools softer and more easily voided in cases of 
haemorrhoids, fissures of the anus, and after surgical operations about 
the pelvic organs. It is used also as a laxative in shin-diseases, chronic 
rheumatism, sciatica, and lead-cachexia, conjoined usually with sulphur- 
baths, the sulphurous mineral waters, and other appropriate medication. 

Prjxvis Gltcykehizje Compositus is an efficient laxative. It is 
made as follows : Senna-leaves, 3 vj ; liquorice-root, 3 vj ; fennel-seeds, 
3 iij ; sulphur, 3 iij ; refined sugar, 3 xvij. M. Sig. A teaspoonf ul 
at a dose. 

Magnesia. — Magnesia. Maguesii carbonas (carbonate of magnesia). 

Actions and Uses. — A mild antacid laxative. In the stomach it 
neutralizes any free acid it meets with, and the resulting salt has a laxa- 
tive action. It is used to correct acidity, the carbonate being preferred 
when there is an irritable state of the stomach, because the carbonic 
acid, which is set free by the action of the stomach acid, is a local seda- 
tive and anodyne. If magnesia does not enter into combination "with 
the stomach acid, no laxative effect is produced. Under these circum- 
stances a solution of citric acid or lemonade, taken after the magnesia, 
will cause it to act. Magnesia is a useful antacid and laxative in sick- 
headache, especially when accompanied by acidity and constipation. It 
has been employed also in gouty affections, and in lithiasis (uric acid) ; 
but it is much inferior to the potash salts in these affections. In the 
intestinal indigestion of infants, attended with flatulence, magnesia is 
much prescribed in conjunction with carminatives. The following is 
Dewees's formula for flatulent colic and diarrhoea in infants: IJ. Mag- 
nesii carbonat., 3 ss ; tinct. asafcetidoe, gtt. xl ; tinct; opii, gtt. xx ; 
sacchari, 3 j ; aquae destil., § j. M. Sig. Twenty drops to a teaspoon- 
ful, according to age. The carminative of Dalby is similar in composi- 
tion : IJ. Magnesii carbonat. 3 ij ; ol. menth. pip., gt. j ; ol. myrist., gtt. 
ij ; ol. anisi, gtt. iij ; tinct. castor., gtt. xxx ; tinct. asafoetid., gtt. xv ; 
tinct. ol. hedeofnae, gtt. xv ; tinct. cardam. comp., gtt. xxx; aquae men- 
thse pip., 3 ij. M. Sig. A teaspoonful, as necessary. 

Magnesia is frequently combined with other purgatives because of its 
antacid property. The following is Meigs's formula, gelsemium having 



CATI1ARTICS. 50 1 

been substituted for henbane: fy. Magncsii carb., 3ss; magncsii sul- 
phat., 3 iij ; spts. ammonia; arotnat., 3j; tinct. rhei, fss; tinct. gelse- 
mii, 3 ss ; aquse menthae pip., 3 iv. M. Sig. A tablespoonful two or 
three times a day. 

It is unsafe to use magnesia in large quantity for lengthened 
periods, owing to the fact that it may form intestinal concretions — 
a hydrate of magnesia. Instances of this kind have been reported. 

Freshly -precipitated hydrate of magnesia is an antidote to arsenious 
acid in solution, but it is not so effective as the hydrated scsquioxide of 
iron. 

Oleum Iiiciai. — Castor-oil. Suite de ricin, Fr. ; Castordl, Ger. 
The fixed oil as obtained from the seed of ricinus communis. Dose, 

3j— 3J- 

Properties and Composition.— Castor-oil has a pale amber-color, 
a rather nauseous taste, and is quite viscid. Cold increases the viscid- 
ity. It has a specific gravity of about 0.96. It contains several fatty 
acids — palmitic and ricinoleic — the latter peculiar to castor-oil. The 
seeds appear to contain a drastic constituent, which is more powerfully 
purgative than the oil. The purer the oil, the less active its purgative 
property. 

Actions and Uses. — Castor-oil is a mild but very certain and 
efficient laxative. It operates in from four to six hours, causing but 
little pain, and producing copious stools. It increases but slightly the 
intestinal secretions — kence the stools are not very liquid. Its purga- 
tive principle enters the blood, and the milk of the mother may in this 
way acquire a purgative property. It does not appear to have any effect 
upon the hepatic secretion. Rohrig's experiments, which demonstrated 
this point, have been confirmed by the subsequent investigations of 
Rutherford and Vignal. After the action of castor-oil has been com- 
pleted, it may not unf requently be seen floating on the stool ; yet Buch- 
heim (Hxisemann) has been unable, after careful examination of the 
fasces, to discover in them castor-oil or any of its derivatives. 

Castor-oil is justly held in great esteem as a laxative for children, 
for pregnant women, for the puerperal state. When hardened foeces 
and irritating suhstances are to be removed from the intestinal canal, 
castor-oil is the most efficient purgative compatible with safety. When 
inflamed haemorrhoids, fissures of the amis, or surgical operations on 
the pelvic viscera, require the use of a mild, certain, but unirritating 
laxative, castor-oil should be selected. Unfortunately, -its taste is so 
repugnant to many palates, that no considerations will overcome the 
disgust which it excites. No remedy is more useful in. the diarrhoea of 
children, induced and maintained by undigested aliment or irritating 
secretions. It is judicious practice, in these cases, to give a laxative 
dose of castor-oil to empty the canal, and follow it with an opiate or 
enema of laudanum. The dysentery of children, and sporadic dysen 
37 



cucma 



562 EVACUANTS. 

tery of adults^ especially after the more acute febrile symptoms have 
subsided, are generally very successfully managed by an emulsion of 
castor-oil: 1J. 01. ricini, § j ; mucil. acacia?, syrp. simplicis, aa §"ss; 
aquae cinnamomi, 3 ij. M. Sig. A tablespoonful every four to six 
hours. In cases of dysentery, when there are much pain, tenesmus, and 
frequent passages, ten to twenty drops of laudanum may be added to 
each dose ; when there are much depression, a low state of the arterial 
tension, and a dry, glazed tongue, five drops of turpentine may also be 
added. 

A poultice made of the leaves of the castor-oil plant applied to the 
breasts, it is said, has the power to promote the secretion of milk. 
Warm applications to the mammae undoubtedly stimulate their func- 
tional activity, but it is questionable whether castor-oil leaves have a 
special galactagogue property. It is said, however, that the inhabitants 
of the Cape Verd Islands have long been acquainted with this supposed 
property. The internal use of a fluid extract of the leaves has also, it 
is supposed, the power to determine an increased secretion of milk. 
Jaborandi will probably prove to be more effective in this respect than 
the ricinus communis. 

Saline Purgatives. — Many of these have been discussed elsewhere ; 
some of them are no longer employed in medical practice. The sulphate 
and the citrate of magnesium may be regarded as typical representa- 
tives of the class, and hence, in a statement of their physiological ac- 
tions and therapeutical applications, may be comprehended all that is 
immediate and of practical value on the subject. 

Magnesii Sulphas. — Sulphate of magnesia. Sulfate de magnesie, 
Fr. ; Bittersalz, Ger. " In colorless crystals, which slowly effloresce 
on exposure to the air, and are very soluble in water." Dose, 3 j — 

Ij- 

Magnesii Gitras (Liquor, officinal). — In two forms : 1. As a granu- 
lar salt, consisting of citrate of magnesium, bicarbonate of soda, and cit- 
ric acid ; 2. In solution (liquor magnesii ditratis) in a tightly-secured 
corked bottle. A tablespoonful of the granular salt added to a half-tum- 
blerful of water, and drunk during effervescence, is the quantity and 
the form in which it is taken. The bottled solution, which is also highly 
effervescent, must be drunk immediately on being poured out. It is a 
pleasant drink, and, when properly prepared, an active cathartic. 

Physiological Actions of Saline Purgatives. — As a general 
rule, saline cathartics are easily borne by the stomach ; especially is this 
true of the Epsom salts. The purgative action is due chiefly to increase 
of the intestinal secretions, and hence the stools are large and watery. 
Thiry and Radziejewski had apparently demonstrated that all purga- 
tives acted by increasing the peristaltic movements, but exactly oppo- 
site results have been obtained by Moreau, whose observations have 









CATHARTICS. _ 563 

been confirmed by Vulpian and Brunton. The conclusion reached by 
the last-named observer is expressed as follows : " Such positive results 
as these seem to prove that purgatives do cause a flow from the intesti- 
nal wall, quite as conclusively as experiments with Thiry's fistula do the 
opposite ; and, as the conditions under which the purgatives act on the 
intestines more nearly approach the normal in Moreau's than in Thiry's 
experiments, there can be little doubt that purgatives produce a decided 
secretion of fluid from the intestines, as well as accelerate peristaltic 
movements." Of the agents employed by Brunton in his experiments 
— croton-oil, elaterine, gamboge, jalapin, and sulphate of magnesia — the 
greatest secretion was caused by the latter. The results of the best 
directed experiments are, therefore, in accord with clinical observations, 
and it may hence be considered as established that saline cathartics 
produce an outpouring of fluid into the intestinal canal. This outward 
osmosis occurs chiefly from the vessels, and is not truly a secretion of 
the glandular appendages of the mucous membrane. 

Therapy. — The saline purgatives are indicated in acute inflamma- 
tory affections, as a part of the denutrition treatment. If the arterial 
tension is abnormally high, purgatives, especially the salines, lower it, 
as the sphygmographic tracings slow. "When a considerable quantity 
is withdrawn from the intestinal vessels, the blood-pressure is necessa- 
rily diminished elsewhere (Brunton). Free transudation from the blood- 
vessels of the intestinal canal lessens the amount of work which the kid- 
neys have to do, and, if these organs are hyperaemic, removes the con- 
gestion. Saline cathartics are therefore very important remedies in 
the treatment of renal and cardiac dropsy. Free purgation, also, 
influences the condition of the kidneys by reflex action. As a result 
of the lessened hyperemia of the kidneys, the diminution of the blood- 
pressure, and the reflex stimulation of these organs, the action of 
a purgative is often followed by greatly-increased activity of the renal 
function. In ascites from obstruction of the portal circulation, saline 
cathartics are even more conspicuously beneficial than in general dropsy 
— for in this case they affect directly the organs involved. Cholcemia, 
ttrcemia, oedema of the brain, increased intra-cranial blood-pressure 
from any cause, are conditions requiring the use of active saline ca- 
thartics. 

The most important applications of saline cathartics are in the treat- 
ment of various intestinal disorders. When the stomach is irritable, 
and the intestines inflamed, no other purgative is so well borne as Ep- 
som salts, and its use may be resorted to, when any other agent of the 
kind would be inadmissible. Impaction of the coscum and typhlitis, 
resulting from this cause, may be removed by the proper administration 
of this remedy. It is unsafe, by active and drastic purgatives, to at- 
tempt to unload the bowel — for these harsh measures will only aggra- 
vate the existing inflammation. Epsom salts will liquefy the fecal 



564 EVACUANTS. 

masses and deplete the vessels, and thus remove the obstruction with- 
out causing any irritation. Small doses frequently repeated are more 
suitable than a large purgative dose. Usually about a teaspoonful in a 
wineglassful of water, every three hours, will be the quantity required. 
Perityphlitis and the peritonitis arising from inflammation and perfora- 
tion of the appendix vermiformis are conditions in which purgatives of 
any kind are inadmissible. 

The constipation which ^accompanies lead-colic can be overcome by 
Epsom salts, fy. Magnesii sulphatis, §j; acidi sulphuric, dil., 3j; 
aquae, f iv. M. Sig. A tablespoonful every three hours. As Brunton 
has pointed out, the administration of Epsom salts is a very important 
expedient in the treatment of the saturnine cachexia. Lead, as well as 
other minerals, mercury and copper, for example, is eliminated with 
the bile, and is discharged into the intestine, where it is again ab- 
sorbed. For an indefinite period, therefore, the absorption and dis- 
charge of the same metal may be going on ; and hence the utility of 
giving purgative doses of Epsom salts during the treatment of lead-poi- 
soning. 

The most efficient treatment of acute dysentery is by the adminis- 
tration of sulphate of magnesia. It is especially adapted to the acute 
stage when there are fever, pain, tenesmus, and stools of mucus and 
blood. It lessens the hyperasmia and causes fecal evacuations, with the 
result of relieving the pain and the distressing straining. It is admin- 
istered as follows : Take a sufficient quantity of sulphate of magnesia to 
saturate seven ounces of water, and to this saturated solution add one 
ounce of diluted sulphuric acid. The dose of this is a tablespoonful 
every hour or two, in a wineglassful of water, until it operates. Sul- 
phate of morphia may be combined with it, or starch enemata with 
laudanum may be employed. 

The bleeding from haemorrhoids may sometimes be arrested by the 
above-described solution of Epsom salts and sulphuric acid, especially if 
the state of the hsemorrhoidal vessels be due to constipation. Uterine 
hemorrhage caused by the presence of a fibroid, or by subinvolution, and 
congestion of the pelvic viscera, are not unfrequently relieved by the 
same agent when other agents apparently more powerful fail. When 
congestion of the pelvic organs, constipation, and anaemia coexist, the 
following is an efficient remedy : R . Magnesii sulphat., 5 j ; ferri 
sulphat., manganesii sulphat., aa 3 j ; acid, sulphur, dil., 3 ij ; aquas, 5 iv. 
M. Sig. A tablespoonful in a wineglassful of water each morning 
before breakfast. For habitual constipation in those of full habit and 
' active circulation, a daily morning dose of a teaspoonful of Epsom salts 
is often a permanently effective remedy. 

The disagreeable taste of Epsom salts is perfectly well covered by 
coffee. Boil for two minutes in an earthen vessel one ounce of sul- 
phate of magnesia, two and a half drachms of roasted coffee in a pint 



CATIIARTiCS. 5G5 

of water; then remove from the fire, allow it to "draw " for a few min- 
utes and strain. 

The other saline purgatives belonging to this group are : 

Soclii Sulphas, sulphate of sodium, Glauber's salts, 

Potassii Sulphas, sulphate of potassium; but both of these have 
long since ceased to be used. 

Soclii Phosp>has, phosphate of soda, 

Potassii et Soclii Tartras, tartrate of potassium and sodium, Ro- 
chelle salts, and 

Pulveres Effervescentes Aperientes, effervescing aperient powders 
or Seidlitz powders, have been considered elsewhere. 

Potassii Pitartras, bitartrate of potassium, cremor tartar, may also 
be regarded as a member of this group, although it has but feeble pur- 
gative property. 

Mercurial Purgatives. — As the actions and uses of the mercurial 
preparations have been sufficiently discussed elsewhere, little need be 
said in addition as respects their applications as purgatives. 

Hyclrargyri Chloridum Mite. — Mild chloride of mercury. Calo- 
mel. Dose as a cathartic, gr. j — grs. x. 

Pilulce Hyclrargyri. — Mercurial pill. Blue mass. Dose, grs. v — 
grs. xv, as a cathartic. 

Actions axd Uses. — These mercurial purgatives are rather slow in 
their action. A dose at bedtime will usually operate during the course 
of the following morning. One grain of calomel or five grains of mer- 
curial pill will produce distinct purgative effects in most persons in 
about twelve hours, unless there be considerable habitual torpor of the 
bowels. They are apt to cause griping pains, nausea, and even vomit- 
ing, when the purgative effects begin. First brownish and bad-smell- 
ing, and afterward greenish stools, supposed formerly to be character- 
istic of the mercurial action, are produced. Much heated discussion 
has arisen as to the cholaffogrue action of mercurv. Without entering 
into details on this point, it may be admitted that bile-elements are 
found in the stools from the action of mercury, as they are unquestion- 
ably found in the stools caused by some other purgatives. The presence 
of bile-elements in the faeces discharged only proves that mercurial 
cathartics swept them out with the other contents of the intestinal 
canal, and does not prove that an excitant action was exerted on the 
secretory function of the liver. The stored-up bile in the gall-bladder 
may be emptied into the intestine in obedience to a reflex influence 
transmitted from the intestinal mucous membrane irritated by the pur- 
gative. Experimental investigations must be invoked to determine the 
question whether mercurials actually stimulate the liver to the produc- 
tion of an increased quantity of bile. In another place the experiments 
of Hughes Bennett's Edinburgh Committee have been stated. As these 



566 EVACUANTS. 

pages are going- through the press, the very accurate and painstaking 
investigations of Rutherford and Vignal are being published. Rcihrig 
had already determined as the result of his experiments that " with 
large doses (twenty grains for a dog) it rarely happened that the secre- 
tion of bile was recalled after it had come to a standstill, although this 
agent can increase the secretion when it is only diminishing." Ruther- 
ford and Yignal arrived at the following conclusions as the results of 
their experiments with calomel : " 1. An increase of the biliary secre- 
tion followed the administration of two successive doses of ten grains 
of calomel in one case (Experiment 30). Diminution of the secretion 
was the only result of the same doses given under similar circumstances 
in other two cases (Experiments 31 and 32) ; and it was the most defi- 
nite result of the administration of four successive doses of three grains 
in another case (Experiment 33). 2. In all the four experiments the 
calomel had a purgative effect. 3. Analysis of the bile secreted during 
the calomel purgation in Experiment 33 showed that, notwithstanding 
a diminution in the quantity of bile secreted, the percentage amount of 
solids had become less." The results of experiment render it probable 
that mercurials do not increase the secretion of bile. 

That the purgative action of mercurials has a distinctive and pe- 
culiar quality, a vast clinical experience attests. The stools are rather 
different from those caused by other purgatives, and the therapeutical 
effects are, it is generally held, sui generis. Whatever peculiarity per- 
tains to the purgative action of mercurials is probably due to the fact 
that they greatly increase the elimination of the products of waste, or 
retrograde metamorphosis of tissue, by the intestinal glandular appa- 
ratus. 

As a purgative the use of mercury is restricted to those cases in 
which a deficiency of bile is supposed to be the cause of the morbid 
state — clay-colored stools, jaundice from catarrh of the gall-ducts, and 
to those cases, singularly enough, in which bile is supposed to be in 
excess — biliousness, so called, jaundice from excessive production of 
bile, etc. For further remarks on the actions and uses of mercury the 
reader is referred to the section on remedies used to promote destruc- 
tive metamorphosis. 

TONIC-ASTRINGENT AND RESIN-BEARING PURGATIVES. 

Senna. — Senna. Feuilles de s'm'e, Fr. ; Sennesblutter, Ger. " The 
leaflets of cassia acutifolia, of cassia obovata, and of cassia elongata." 

Confectio Sennm. — Confection of senna. (Senna, coriander-seed, 
liquorice," figs, prunes, tamarinds, cassia.) Dose, 3 j — 3 ij. 

Extractum Sennm Fluidum. — Fluid extract of senna. Dose, 3 ss. 

Infusum Sennce. — Infusion of senna. (Senna, 3 j ; coriander-seed, 
3 j ; boiling water, Oj.) Dose, 3 iv. 



CATHARTICS. 5G7 

Composition. — The active constituents of senna prove to be a pe- 
culiar colloid body, and au acid, to which has been given the name 
cathartic acid. It has been shown that " cathartate of ammonia pos- 
sesses, in a concentrated form, the purgative activity of the original 
drug." Two bitter principles have been obtained from senna — senna- 
crol and sennapicrine. It contains also a peculiar sugar — catharto- 
mannite. 

Actions and Uses. — The taste of senna is nauseous and bitter. In 
infusion — the form in which it is most usually prescribed — it is most 
disagreeable in odor as well as taste. It produces a sense of warmth in 
the stomach, and causes much flatulence and griping', which may, how- 
ever, be prevented by combination with aromatics. Its active principles 
are absorbed, and the milk of the mother taking senna acquires a pur- 
gative property. It is a very efficient cathartic, producing copious 
liquid stools in about four hours. It does not cause inflammation or 
hypercatharsis, and its purgative action is not followed by intestinal 
torpor and constipation. It is, therefore, a very safe and serviceable 
cathartic, if it were not so disagreeable. 

The confection of senna is a palatable preparation, and a mild laxa- 
tive, operating without any disturbance. It is used chiefly to correct 
the constipation of pregnancy, but it is highly prized by some patients 
as a remedy for habitual constipation. It is also taken to procure soft 
and easy evacuations in haemorrhoids, fissures of the anus, etc. A 
large bolus (one hundred and twenty grains), taken at bedtime, will 
operate gently on the following morning. The fluid extract of senna 
is a form for the administration of this drug more agreeable than the 
infusion. These two preparations are very excellent cathartics to over- 
come constipation, especially when ordinary purgatives fail. 

The action of senna is much improved by combination with other 
purgatives, and with aromatics. The well-known " black draught " is 
an infusion of senna with sulphate of magnesia — one ounce of the latter 
dissolved in four ounces of the former. By the addition of coffee, the 
odor and flavor of senna may be rendered more tolerable. Two drachms 
of senna and one drachm of coffee may be infused in three ounces 
each of hot milk and boiling water, and the whole drunk after twelve 
hours. 

Rheum. — Rhubarb. JRhubarbe, Fr. ; Rhabarber, Ger. " The root 
of rheum palmatum, and of other species of rheum." 

JExtractum JRhei. — Extract of rhubarb. Dose, grs. x — grs. xv. 

Extractum Rhei Fluidum. — Fluid extract of rhubarb. Dose, 3 ss 
— 3 ij- 

Infusum Rhei. — Infusion of rhubarb. Dose, § ss — 3 ij. 

Piluloi JRhei. — Rhubarb-pills. Each pill contains three grains of 
rhubarb and one grain of soap. 



568 EVACUANTS. 

Pilulve Hhei Compositce. — Compound pills of rhubarb. (Rhubarb, 
socotrine aloes, myrrh.) Dose, 2 — 4 pills. 

Syrupus Jihei. — Sirup of rhubarb. (Fluid extract, § iij ; simple 
sirup, 3 xxix.) Dose, 3 ss — 3 ij. 

Syrupus Jihei Aromaticus. — Aromatic sirup of rhubarb. (Rhu- 
barb, cloves, cinnamon, nutmeg.) Dose, 3 ss — 3 ij. 

Tinctura Mhei. — Tincture of rhubarb. Dose, 3 j — 3 ss. 

Tinctura JRhei et Sennce. — Tincture of rhubarb and senna. "War- 
ner's gout cordial. Dose, § ss — § ij. 

VinumUhei. — Wine of rhubarb. (Rhubarb, canella, sherry.) Dose, 
3 j— I ss. 

Composition. — Rhubarb contains a number of substances which have 
been isolated, but its composition has not yet been accurately deter- 
mined. It contains two acids, rheo-tannic and rheumic, a resinous body, 
phceoretine, and chrysophan, or chrysophanic acid. 

Physiological Actions. — In small doses, rhubarb is a tonic astrin- 
gent. It promotes the appetite and the digestive power, and, by virtue 
of its tannin, is astringent and diminishes peristalsis. As it contaius 
also a purgative principle, in sufficient doses cathartic effects follow its 
administration. The stools are stained by the coloring-matters of the 
rhubarb, are of a yellowish-brown color, and are rather soft without 
being watery. After the purgative action has ended, the astringent 
constituents assert their power and constipation results. As the stools 
present an appearance to which the term " bilious " was applied, it was 
formerly supposed that rhubarb had the power to increase the flow of 
bile; more recently it has been universally conceded that the color- 
ing - matter of rhubarb produces the peculiar tint referred to. The 
latest investigations of Rutherford and Vignal have, apparently, very 
conclusively shown that rhubarb really possesses the property anciently 
ascribed to it, and that it must be placed among the cholagogue medi- 
cines. As it is now known to increase the flow of bile, it may be as- 
sumed that the intestinal secretions in general are promoted by it. 
These effects, which indeed are produced by all the purgatives contain, 
ing a resin, are probably due to phasoretine — the rhubarb resin. 

The coloring-matters of rhubarb stain the perspiration, milk, and 
urine, and the milk acquires a bitter taste and purgative properties. 

Therapy. — The infusion of rhubarb is frequently employed as a 
vehicle for the administration of alkalies and mineral acids, in stomachic 
disorders. In small doses, the tincture is an excellent stomachic tonic 
in dyspepsia, with deficient biliary and intestinal secretions. It is adapted 
to those of a relaxed habit, and is inadmissible when an hyperasmia of 
the mucous membrane exists. 

Rhubarb is a remedy of the greatest utility in the duodenal catarrh, 
and in the catarrh of the biliary ducts loith jaundice, as these maladies 
occur in children. The passing of whitish, pasty, or clay-colored stools. 



CATHARTICS. 509 

while the skin presents an earthy or jaundiced hue, is the indication 
for the use of rhubarb. It is true that the stools will be quickly stained, 
so as to present the bilious character, without any improvement having 
necessarily taken place in the local malady ; but it is also true that 
rhubarb is curative in the conditions above described. In the summer 
diarrhoea of children, no remedy is more generally prescribed. The 
aromatic sirup of rhubarb is a pleasant form in which to administer it. 
In this disorder, especially if the motions are sour, alkalies should be 
prescribed with the rhubarb. Magnesia, chalk, or sodium carbonate, 
may be given with the powder of rhubarb, the fluid extract, or the sirup. 
The following is an excellent formula in these cases: I£. Infus. rhei, 
3 iij ; potassii bicarb., 3 j ; tinct. cinnamomi, 3 ij ; syrp. simplicis, 3 vj. 
M. Sig. A teaspoonful every hour or two in cholera infantum. Diar- 
rhoea in children or adults, due to the presence of undigested food, or 
retained irritating secretions, may not unfrequently be cured by a pur- 
gative dose of some rhubarb preparation. After the purgative effect is 
expended, the bowels are confined by the astringent. In acute dysen- 
tery the saline purgatives are much more appropriate than rhubarb. 

In habitual constipation good effects may be obtained by chewing 
some rhubarb-root. The astringent after-effect is, however, a decided 
objection to the frequent use of this remedy for this purpose. In the 
rhubarb-pill the astringency is counteracted by soap. The compound 
rhubarb-pill, which contains aloes, is a mild and efficient cathartic. 

Aloes. — Aloe Barbadensis. — Barbadoes aloes. The inspissated juice 
of the leaves of aloe vulgaris. 

Aloe Capensis. — Cape aloes. The inspissated juice of the leaves 
of aloe spicata, and of other species of aloe. 

Aloe Socotrina. — Socotrine aloes. The inspissated juice of the 
leaves of aloe socotrina. 

Aloe Purificata. — Purified aloes. " In brittle pieces of a dull-brown 
or reddish-brown color, and having the peculiar aromatic odor of Soco- 
trine aloes. It is almost entirely soluble in alcohol." Dose, gr. j — 
grs. v. 

Pilulm Aloes. — Pills of aloes. Each pill contains two grains of 
aloes, and two grains of soap. Dose, 1 — 5 pills. 

Pihdoe Aloes et Asafcetidoz. — Pills of aloes and asafcetidae. (Aloes, 
asafcetida, and soap, in equal parts.) Dose, 2 — 5 pills. 

Pilulm Aloes et Mastiches. — Pills of aloes and mastic. Lady Web- 
ster's pills. (Aloes, mastic, and red rose.) Dose, 1 — 2 pills. 

Pilxdoz Aloes et Myrrhoz. — Pills of aloes and myrrh. (Aromatic 
powder, myrrh,, aloes.) Dose, grs. v — grs. xv. 

Tinctura Aloes. — Tincture of aloes. Dose, 3 ss — § j. 

Tinctura Aloes et Myrrhoe. — Tincture of aloes and myrrh. Dose, 
3 ss — 3 ij. 



570 EVACUANTS. 

Vinum Aloes. — Wine of aloes. Dose, 3 j — § ss. 

Pulvis Aloes et Canellce. — Powder of aloes and canella (hiera picra). 
Dose, grs. v — 3 j. 

Composition. — The odor of aloes is due to a peculiar volatile oil. 
It contains also a resin, and a principle, alo'lne. The composition of 
aloi'ne is not precisely the same in the different varieties of aloes. The 
Barbadoes aloes furnishes barbalo'ine, the Natal aloes, natalo'ine, and the 
Socotrine aloes, soalo'ine. These varieties, it is supposed, constitute an 
homologous series. 

Actions and Uses. — Aloes has a bitter and very disagreeable taste, 
leaving a rather acrid after-sensation in the fauces. It is a stomachic 
tonic, and, like bitters in general, it promotes the appetite and diges- 
tion. Accordingly, it is much prescribed as a stomachic tonic in cases 
of indigestion with torpor of the large intestine. Irritable or inflam- 
matory states of the stomach mucous membrane contraindicate its em- 
ployment. 

The recent investigations of Rutherford and Vignal have shown that 
aloes has the power to stimulate the hepatic functions, and to promote 
the flow of bile. This result is confirmatory of clinical experience. In 
large doses (twenty grains or more) aloes undoubtedly increases the 
intestinal secretions generally ; but, in the ordinary medicinal laxative 
dose, the stools are not liquid, and are but little altered in character. 
The pi'incipal effect of aloes is expended on the large intestine, the 
peristaltic movement of which it increases. Some tormina is expe- 
rienced when the laxative effect begins, and tenesmus, with heat and 
irritation of the rectum, is produced when an active purgative dose 
has been taken. The blood-supply to the pelvic organs is increased by 
aloes; the menstrual . flow becomes more abundant; in the male, erec- 
tions take place more frequently, and abortion, it is said, may be caused 
by its incautious administration. 

Ten or twelve hours elapse after it has been swallowed, before ca- 
thartic effects are produced. The rate at which it moves to affect the 
intestinal canal is influenced less by the size of the dose than by the 
condition of the bowels. 

The purgative principle of aloes diffuses into the blood. Applied 
to an exposed surface it is absorbed and purges, and the milk of moth- 
ers taking it acquires a purgative action. 

Simple jaundice, of an atonic kind, may be cured by aloes. No 
purgative is more efficient in constipation, dependent on weakness and 
impaired contractility of the muscular layer of the large intestine. 
Jaundice, or at least a bilious state, a coated tongue, foul breath, a 
tumid abdomen, and an impacted colon, are conditions frequently asso- 
ciated and are readily relieved bj' aloes. The constipation of hypochon- 
driasis and melancholia is best overcome by the use of this agent, and, 
with the removal of the impacted fasces, there is not unfrequentfy an 






CATHARTICS. 571 

improvement in the mental state. Aloes is prescribed in cerebral dis- 
orders, when purgatives are given with a view to a derivative effect. 

In amenorrhcea, which is dependent on anaemia, aloes is prescribed, 
with other appropriate remedies, to determine an afflux of blood to the 
uterine system. Menorrhagia, occurring in debilitated and relaxed 
subjects, is sometimes relieved in the same way. Iron may be asso- 
ciated w r ith aloes in these cases. Congestion of the pelvic viscera is a 
contraindication to the use of aloes, and the existence of haemorrhoids, 
or of a tendency therefor, has heretofore been considered an equally 
positive contraindication. Fordyce Barker has, however, shown that 
aloes has a curative power in certain cases of hmmorrhoids, and notably 
those which occur after delivery. The local condition, under these cir- 
cumstances, is not one of active hyperemia, but really consists in a 
sluggish state of the circulation in the inferior haemorrhoidal veins. It 
can hardly be doubted that aloes would increase the trouble if pre- 
scribed for cases in which there was active congestion of the pelvic 
viscera. Barker also advocates the use of aloes in non-puerperal ha^mor- 
rhoids, but the local condition must be suitable for the use of this 
remedy or the disease will be aggravated. The following are formulae 
proposed by Barker: IjL Pulv. aloes Soc, sapo. Cast., aa 3j; ext. hyos- 
cyami, 3ss; pulv. ipecacuanha?, grs. v. M. ft. pil. no. xx. Sig. One 
pill morning and evening. " When the haemorrhoids are associated 
with an irritable rectum, and with frequent, small, teasing, thin evacu- 
ations, Barker substitutes for the hyoscyamus a small quantity of opium, 
giving also a less quantity of the aloes, as in the following formula : " 
1$. Ferri sulph., 3j; pulv. aloe's Soc, extr. opii aq., sapo. Cast., aa 
grs. x. M. ft. pil. no. xx. Sig. One pill morning and evening. Op- 
polzer also used aloes as a remedy for haemorrhoids, prescribing, when 
there was constipation, aloes and quinia, and, when the bowels were 
not confined, aloes and sulphate of iron. 

The action of aloes, as well as of other resin-bearing purgatives, in 
the condition of anaemia, is promoted by the conjoined use of the bit- 
ters, quinia, iron, and tonics generally. Two grains of aloes, taken at 
bedtime, will cause a satisfactory evacuation on the following day. 
Combination with soap, as in the officinal pil. aloes, and pil. aloes and 
asafcetida, diminishes the drastic, while it increases the efficiency of the 
purgative, action. It is generally better to give aloes by itself, without 
combination with other cathartics; but its purgative effects may be 
greatly enhanced by administering a saline laxative six or eight hours 
after the aloes has been taken. 

A gonorrhoea may, it is said, be cured by the internal use, three 
times a day, of a pill containing two or three grains of aloes. Catarrh 
of the uterus has been treated successfully by aloes rectal enemata. The 
tincture of aloes, diluted to one-half or even more, by water, is a very 
effective injection in gonorrhoea after the acute symptoms have subsided. 



5?2 EVACUANTS. 

Jalapa. — Jalap. " The tuber of exogonium purga, or ipomea jalapa." 
Racine de jalap, Fr. ; Jalape, Ger. 

Extractum Jalapce. — Extract of jalap. Dose, grs. v — 3j. 

JResina Jaldpce. — Resin of jalap. Dose, grs. ij — grs. v. 

Tinctura Jalapce. — Tincture of jalap. Dose, 3 ss — 3 ij. 

JPulvis Jalapce Compositus. — Compound powder of jalap. (Jalap, 
one part ; bitart. of potassa, two parts.) Dose, gr. x — 3 j. 

Composition. — Jalap contains a resin, to which its purgative prop- 
erty is due. The resin consists of two varieties, one soluble, the other 
insoluble, in ether. The latter has been named convolvuline, or jalapine, 
and is the more active purgative of the two. Various secondary prod- 
ucts of considerable interest are obtained from the resin, but these 
possess no special importance from the therapeutical point of view. 

Physiological Actions. — As a cathartic jalap resembles, but it is 
much more active than, senna. It is apt to produce nausea, and tormina 
and tenesmus invariably accompany its purgative action. It usually oper- 
ates in from two to four hours, but the rate at which it moves to affect 
the intestinal canal is not influenced by the amount administered. The 
stools are soft at first, and afterward liquid. Jalap does not produce 
haemorrhoids, nor does it cause a tendency to, or increase an existing, 
menorrhagia. The secretions of the intestinal canal are increased by 
it, and the recent researches of Rutherford and Vignal have demon- 
strated that jalapine (convolvuline) excites the flow of bile. 

The action of jalap appears to be local. It is true that experiments 
in support of a contrary opinion have been made ; but, in the conclu- 
sive test of the intra-venous injection of convulvuline, no purgative action 
has followed (Husemann). 

Therapy. — The resin of jalap being the active constituent, it should 
generally be preferred. It has the merit of being almost tasteless, and 
hence may be given readily to children. 

Jalap is an efficient cathartic in the beginning of fevers, inflamma' 
tions, and acute diseases, requiring the use of such therapeutic means. 
Formerly calomel and jalap were much prescribed, but this combina- 
tion has deservedly fallen into' discredit. Occasionally the resin and 
calomel, in less ponderous doses than formerly given, may be used with 
advantage as a cathartic : IjS, • Resinae jalapse, hydrarg. chlor. mit., ext. 
hyoscyami, aa gr. j. M. ft. pil. no. j. Sig. Take at bedtime. 

As jalap in sufficient quantity causes free watery evacuations, it is 
a suitable purgative in anasarca and ascites. The most generally ap- 
proved hydragogue purgative, under these circumstances, is the com- 
pound jalap-powder. The efficiency of this may be increased by the 
addition of podophyllum. A teaspoonful of the compound powder, 
taken in the early morning, will usually produce several very copious, 
watery stools. Increased urinary discharge also is a not unfrequent 
result of its action. 



CATHARTICS. 573 

Jalap has the power to cause the expulsion of lumbrici. As a ver- 
mifuge it is not at all equal to the other approved remedies, but it is 
certainly useful as an adjunct. For example, santonine at night, and the 
resin of jalap and calomel on the following morning, is an effective 
method of expelling these parasites. 

Jalap is, of course, contraindicated in inflammatory states of the 
intestinal canal. In overdoses it causes hypercatharsis, and it may 
excite violent gastro-enteritis and endanger life. With proper attention 
to the conditions in which it is admissible, and to the dosage, jalap is 
entirely safe, and is a very certain and efficient cathartic. An excellent 
vehicle for the administration of the resin of jalap is the sirup of rhu- 
barb. R. Resinas jalapse, grs. ij — grs. v; syr. rhei aromat., § ss. M. 
This is especially suitable for children. 

ScammOEium. — Scammony. "A resinous exudation from the root 
of convolvulus scammonia." Scammonee, Fr. ; Scammonium, Ger. 

Resina Scammonii. — Resin of scammony. Dose, grs. v — grs. x. 

Composition. — The activity of scammonj-, as a cathartic, depends 
entirely on the resin which it contains. As the crude scammony is 
much adulterated, the resin is alone worthy of confidence. 

Actions and Uses. — Scammony corresponds very closely to jalap in 
the time it requires to cause cathartic action, in the character of the 
stools produced, and in the kind of irritation which it excites. Scam- 
mony is somewhat more drastic than jalap. As it has but little taste, 
and is at the same time very active, the resin is much prescribed by 
English practitioners as a cathartic for children. It may be given 
rubbed up with milk, or with sirup of rhubarb. It is adapted to 
the same class of cases, and to the relief of the same conditions, as 
jalap. 

Colocyntllis. — Colocynth. " The fruit, deprived of its rind, of citrul- 
lus colocynthis." Coloquinte, Fr. ; JToloqninten, Ger. 

Extractum Colocynthidis. — Extract of colocjnth. 

Extractuin Colocynthidis Compositum. — Compound extract of colo- 
cynth. (Extracts of colocynth, scammony, and aloes ; cardamoms, 
. soap.) Dose, grs. v — grs. x. 

JPiluke Catharticce Composite. — Compound cathartic pills. (Com- 
pound extract of colocynth, extract of jalap, calomel, gamboge.) Dose, 
1 — 3 pills. Each pill contains one grain of calomel. 

Composition. — Colocynth contains a bitter principle {colocynthine) 
which is the purgative principle. Colocynthitine is another substance 
contained in the alcoholic extract. It differs from colocynthine in being 
soluble in ether, and not in water. As colocynthitine is a tasteless 
crystalline powder, it is probably devoid of purgative property. Coh> 
cynthine is a very powerful cathartic. 



574 EVACUANTS 

Actions and Uses. — Colocynth is a gastrointestinal irritant. In 
moderate doses it hastens the peristaltic movements, and increases the 
intestinal secretions. Its cathartic operation is usually attended with 
griping, and the stools are fluid. Violent gastro-enteritis may be pro- 
duced by a large quantity, and numerous fatal cases have been reported 
from its incautious or criminal administration. 

The action of colocynth is not merely local. Applied to the skin of 
the abdomen it causes intestinal pain, and more frequent alvine dis- 
charges. 

Colocynth is never administered alone, but usually in combination 
with other purgatives. The compound extract is a safe, effective, and 
not unpleasant cathartic for the relief of constipation. R. Ext. colo- 
cynthides comp., 3j; ext. belladonna?, ext. physostigmatis, aa grs. v. 
M. ft. pil. no. x. Sig. One each night in habitual constipation. The 
officinal compound cathartic pill is a most serviceable combination. In- 
stead of calomel the resin of podophyllum may be used in the prepara- 
tion of this pill, without impairing its utility. 

In cerebral congestion the preparations of colocynth are used as 
derivative purgatives. Hypochondriasis and melancholia, when asso- 
ciated with torpor of the large intestines and fecal accumulations, are 
benefited by brisk purging with the colocynth preparations, but other 
drastic purgatives are equally efficient. 

Colocynth is inadmissible in inflammatory states of the intestinal 
canal, and is unsafe during the existence of pregnancy. There is a 
popular notion, which has led to its use in toxic doses, that colocynth 
may cause abortion. Any quantity which will affect the gravid womb 
must be sufficient to endanger life. 

Podophyllum. — May-apple. The rhizoma of podophyllum peltatum, 

Resina JPodophylli. — Resin of podophyllum. Dose, gr. \ — gr. j. 

JEJxtractum Podophylli. — Extract of podophyllum. Dose, grs. v 
—grs. x. 

Composition. — The medicinal qualities of podophyllum are due to 
a resin, or to two resinous substances, one soluble in alcohol and ether, 
and the other soluble in alcohol only. Both possess purgative proper- 
ties. May-apple-root contains the alkaloid berberina, which, however, 
is not peculiar to podophyllum, being found in berberis, hydrastis, and 
other plants. 

Resina podophylli is the preparation entitled "podophylline" by the 
eclectic practitioners. 

Actions and Uses. — The taste of podophyllum is bitter, with an 
after-sense of acridity. It increases the intestinal secretions and is 
actively cathartic, producing copious and rather watery stools. Its action 
is similar to, but considerably slower than, that of jalap. From six to ten 
hours elapse after its administration before cathartic effects are expe- 



CATHARTICS. 575 

rienced. Taken by itself it is apt to cause nausea and griping, but in 
combination -with other cathartics, or with belladonna or hyoscyamus, it 
operates pleasantly as well as efficiently. The Edinburgh committee, 
Dr. Bennett, chairman, ascertained, as they supposed, that the resin of 
podophyllum has no cholagogue action, but the more recent as well as 
the more accurately conducted experiments of Rutherford and Vignal 
have apparently demonstrated that it decidedly increases the flow of 
bile, corresponding in this particular to the other resinous cathartics. 

Podophyllum-resin is the most generally useful cathartic in cases of 
constipation, in which the secretions of the glandular apparatus of the 
intestinal canal, and of the liver, are deficient. Habitual constipation, 
due to torpor of the muscular layer of the bowel, may, it is said, be re- 
moved by the nightly use of a small dose of the resin combined with 
belladonna. r>. Resinae podophylli, grs. vj; ext. belladonnse, ext. phy- 
6ostigmatis, aa grs. iij. M. ft. pil. no. xij. Sig. One pill each night. 
It is especiallj- in congestion of the portal circulation, in catarrhal and 
malarial jaundice, and in ascites, that podophyllum-resin acts most 
efficiently and serviceabry. Haemorrhoids that bleed in consequence 
of stasis in the portal circulation, and that are of recent formation, may 
sometimes be cured by a brisk podophyllum cathartic. 

The clinical experience which had shown that the resin of podo- 
phyllum possessed cholagogue powers, long before the experimental 
inquiry was instituted to settle the question, led also to a wide gener- 
alization in the therapeutical uses of this agent. Acting on the liver, 
it was assumed that, in a manner similar to mercury, it must also possess 
similar " alterative " powers. It came to be used as the " vegetable . 
calomel," in the diseases in the treatment of which mercury was sup- 
posed to be essential. It need hardly be asserted that these specula- 
tions have no basis, and that podophyllum, possesses no property in 
common with mercury except its power to purge. 

Leptandra. — Leptandra. " The root of leptandra Virginica." 

There is no officinal preparation. A fluid extract is found in the 
shops, which may be given in the dose of twenty minims to a drachm. 
Leptandrine, so called by the eclectics, is an impure resin obtained bv 
precipitation from the tincture by the addition of water. The dose of 
this preparation is two to four grains. 

Composition. — A crystallizable principle has been obtained from 
the root — leptandria {?). It contains also a resin which, in the impure 
form at present found in commerce, has a distinctly purgative quality. 

Actions and Uses. — Leptandra is an active cathartic in the recent 
state. In the form of the fluid extract, or of the so-called leptandrine, 
it acts mildly, causing somewhat liquid and apparently bilious stools. 
It is held to be cholagogue, and, according to the rules of analogy, this 
claim may be well founded, for other cathartics containing resin, as the 



576 EVACUANTS. 

experiments of Rutherford and Vignal have shown, possess the power 
to increase the- flow of bile. 

It is applicable to cases of disease of the intestinal canal, attended 
by constipation, in which the biliary and intestinal secretions are insuf- 
ficient. 

Iris Versicolor. — Blue flag. " The rhizoma of iris versicolor." 

There are no officinal preparations of this drug. A fluid extract is 
prepared, the dose of which is from twenty minims to a drachm. The 
so-called iridine, an impure oleo-resin, is given in the dose of one grain 
to five. 

Actions and Uses. — Iris versicolor has a bitter, nauseous, and rather 
acrid taste. It is apt to cause severe nausea. The fresh root has ac- 
tively purgative and diuretic qualities, but these are impaired by age. 
The fluid extract and the " iridin " are laxative, and are supposed to 
have cholagogue powers. 

The oleo-resin is prescribed in hepatic and intestinal disorders, and 
in dropsy. There is much evidence tending to show that this remedy 
is really serviceable when the stools are clay-colored, and the skin jaun- 
diced, in consequence of duodenal catarrh and obstruction of the biliary 
ducts. It is said that malarial jaundice maybe cured by this drug, 
and that in bilious remittent fever and in chronic malarial poisoning 
it exerts a favorable influence. 

EuonyniUS, — Wahoo. " The bark of euonj-mus atropurpureus." 

There are no preparations recognized by the United States Phar- 
macopoeia. A fluid extract is prepared for sale, the dose of which is 
twenty minims to a drachm. The eclectic preparation (euonymin) 
consists of the resin and fixed oil, and is prescribed in the dose of a 
half-grain to five grains. 

Composition. — An uncrystallizable and intensely bitter principle has 
been isolated {euonymine). It contains also a crystallizable, a yellow 
and a brown resin, fixed oil, etc. 

Actions and Uses. — Euonymus possesses cathartic properties simi- 
lar to rhubarb, and is an excellent remedy in hepatic and intestinal 
disorders requiring the use of such a remedy. The eclectic preparation 
(euonymin) is a convenient form in which to procure the cathartic 
action of euonymus. Rutherford has shown that it is a highly efficient 



cholagogue. 



HTDRAGOGUE CATHARTICS. 



Gambogia. — Gamboge. Gumme gutte, Ft.; Gummigutt, Ger. A 
gum-resin obtained from the garcinia morella (F. and H.). Dose, gr. j 
— grs. v. 

The only officinal preparation is the compound cathartic pill, of 
which gamboge constitutes about a tenth part. 



CATHARTICS. 577 

Composition. — Gamboge is a mixture of resin and gum, the latter 
constituting from fifteen to twenty per cent. 

Actions and Uses. — Gamboge has no taste at first, but, when 
chewed, an acrid sensation is developed in the mouth. It is irritant to 
the gastro-intestinal canal, increases secretion of the glands, excites 
vomiting and intestinal pain, and purges violently, producing copious 
watery stools. The experiments of Rutherford and Vignal show that 
gamboge is not an hepatic stimulant, but does cause hydrocatharsis. 
Violent gastro-enteritis is set up by large doses, yet but few fatal cases 
have been reported. As vomiting soon follows the ingestion of a large 
dose, this fact may explain the rarity of a fatal result due to its ad- 
ministration. 

Gamboge is rarely prescribed alone as a cathartic, owing to the vio- 
lence and harshness of its operation. Combination with other cathar- 
tics, as in the compound cathartic pill, greatly modifies its action. As 
it is a powerful hydragogue cathartic, it is given with advantage in 
dropsy, when hydrocatharsis is indicated. It is best administered in 
small doses, at short intervals, rubbed up with sugar or made into a 
pill with soap. Besides its purgative properties, gamboge is decidedly 
diuretic. In order to obtain its diuretic effects it must be given in 
small doses, at short intervals, and vomiting must be avoided. Admin- 
istered in solution with an alkaline diuretic, its efficiency is much in 
creased. Gamboge has also been used as an anthelmintic, but it has no 
powers in this respect not possessed by other drastic purgatives. 

Oleum Tiglii. — Croton-oil. " The fixed oil obtained from the seeds 
of croton tiglium." Suite de Croton, Fr. ; Crotonvl, Ger. Dose, gt. j 
— gtt. ij. 

Composition. — It contains glycerides of the fatty acid series — 
stearic, palmitic, myristic, and lauric acids — and the more volatile acids 
acetic, butyric, and valerianic (Fluckiger and Hanbury, Husemann). 
Genther and FrOhlic have discovered a peculiar volatile acid to which 
they have applied the name tiglinic acid. By the same chemists the 
so-called crotonic acid is held to be an artificial product. Schlippe has 
asserted the discovery of the vesicating principle of croton-oil, but other 
chemists have failed to find this substance, to which he has assigned 
the name crotonol. The purgative principle of the oil appears to exist 
in all parts of toe croton tiglium, but it has not yet been isolated. 

Actions and Uses. — Croton-oil is a transparent or semitransparent 
viscid liquid, amber-colored, and having a rather rancid smell, and an 
oily, acrid taste. Applied by friction to the skin it excites inflamma- 
tion, and causes an eruption which is at first papular, with rounded 
summits, and afterward becoming pustular. The eruption is sometimes 
umbilicated, but is generally rounded. An areola surrounds .the pus- 
tules, and there are considerable heat and burning in the part. The 
3S 



578 EVACUANTS. 

eruption appears in a few hours after the frictions have been practised, 
reaches its maximum in about four days, and then declines by abortion 
of the pustules and by scabbing. In many subjects permanent, small 
white cicatrices mark the site of the eruption. All subjects are not 
equally susceptible to the vesicating action of croton-oil. 

The mucous membrane is violently attacked by croton-oil. In the 
fauces it causes an intensely acrid sensation, and increases the flow of 
saliva. A sense of heat, pain, and nausea, are produced when the oil 
is received into the stomach, tormina soon follows, and in an hour or 
two watery stools are passed with some burning and irritation about 
the anus. The action of the oil continues during the succeeding twelve 
to twenty-four hours, numerous fluid dejections are passed, and con- 
siderable debility is the result. When large doses are taken, if not 
rejected promptly by vomiting, violent hypercatharsis occurs,, with 
great prostration and collapse. Fortunately, when an overdose is 
swallowed, vomiting quickly ensues, and hence very large quantities 
have been taken without producing a fatal result. The lesions caused 
by croton-oil are those of gastro-enteritis, but fatal cases have occurred, 
with all the objective phenomena of choleraic collapse, without any 
evidences of local inflammation. 

As croton-oil is still purgative after being deprived of its acrid prin- 
ciple by washing with alcohol, it has been held that the oil becomes 
cathartic only by the action of the alkaline juices of the duodenum. 
Numerous instances have been reported, and some have fallen under 
the author's observation, in which croton-oil applied to the integument 
has produced diarrhoea. It must, therefore, act by absorption into the 
blood. In some cases, without causing purging, croton-oil affects the 
nervous system in a peculiar manner. Thus restlessness, palpitation of 
the heart, headache, giddiness, confusion of ideas, etc., have occurred 
under these circumstances (Husemann). 

R5hrig found that croton-oil stimulated the hepatic function, and in- 
creased the- flow of bile. Radziejewski found peptones, bile, glycogen, 
leucine, and tyrosine, in the stools. Rutherford and Vignal have since 
shown that croton-oil, although it causes great vascular dilatation of the 
vessels of the intestinal mucous membrane, cannot be regarded as a 
cholagogue. 

The principal effect of croton-oil, for which it is administered in 
medical practice, is that of a hydragogue cathartic. It is, therefore, used 
in dropsies when it is desired to procure free watery evacuations. It is 
inadmissible when there is much debility, or when an irritable or inflam- 
matory state of the intestinal mucous membrane exists. 

Notwithstanding its great activity, croton-oil is an easily-managed 
cathartic for ordinary purposes. It is the most efficient purg-ative when 
there is simple impaction, without inflammatory symptoms. The con- 
stipation from lead may be overcome by it, when less powerful purga- 



I 



CATHARTICS. 579 

tives will fail. It is the most appropriate of cathartics, when these 
agents are indicated as revulsives in cerebral congestion. Croton-oil, by 
increasing the vascular dilatation in the intestines, lowers the intra- 
cranial blood-pressure. Per contra, it is harmful when a state of cere- 
bral anaemia exists. 

Croton-oil has been used successfully against taenia, but it has no 
special vermifuge property. 

The smallness of the dose required renders croton-oil a very useful 
purgative in the maladies of children and of the insane. When the 
patient is unable to swallow from insensibility or paralysis, a drop or 
two placed on the tongue will act efficiently. It may be given to chil- 
dren, rubbed up with sugar of milk. As washing with alcohol removes 
the acridity, and does not impair the purgative property, a preparation 
so treated will be best for administration to children. The unpleasant 
effects of this remedy may be much modified by cembination with other 
cathartics: r>. 01. tiglii, gtt. iij; ext. colocynth. comp., £)j; ext. bella- 
donnas, grs. iij. M. ft. pil. no. vj. One of these will usually act effi- 
cientlv. The following is the formula of Dr. Francis's "triplex pills : " 
5. Aloes Socot., scammonii, pil. hydrargyri, aa | j ; ol. tiglii, m. xx; 
ol. carui, m. xc ; elix. proprietatis, q. s. M. ft. pil. no. 400. Dose, as 
a laxative, one at bedtime. 

Elaterium. — Elaterium. "A substance deposited by the juice of the 
fruit of momordica elaterium, ecbalium agreste." Concombre purgatif, 
Fr. ; SpringgurJce, Ger. Dcse, gr. ^ — gr. J. 

Composition. — The important constituent of elaterium is elaterine. 
This principle crystallizes in hexagonal plates or prisms. In taste it is 
acrid and bitter. 

Elaterine. — Dose, gr. -^ in pill. 

Actions and Uses. — Elaterium excites an abundant flow of saliva, 
and a persistent bitter taste is experienced in the fauces some time 
after it is swallowed. Nausea and vomiting, profuse, watery stools, 
and great weakness and prostration are produced by a considerable dose 
of elaterium. The vomited matters and stools have an appearance and 
composition similar to the "rice-water" discharges of cholera. On 
animals elaterium acts somewhat differently. "Without causing purging 
it affects the nervous system, producing irregular respiration, hebetude, 
convulsions, and death (KOhler). The gastro-intestinal action is doubt- 
less local, and the result of the immediate impression made by the agent 
in its passage down the intestinal canal. According to Kohler, the 
presence of bile is necessary to the action of elaterium. 

The chief use of elaterium is to procure free watery evacuations in 
ascites, general dropsy, uraemia, and to act as a revulsive in cerebral 
disorders. It must be used with caution in debilitated subjects. Gas- 
tro-intestinal irritation, or inflammation, contraindicates its use. The 



580 EVACUANTS. 

depression which its operation induces must be counteracted by stimu- 
lants and proper aliment. 

Authorities' referred to : 

Anstie, Dr. F. E. Report on the Physiological Action of Podophyllin. The Medical 
Times and Gazette, voL i., 1863. 

Barker, Dr. Fordyce. The Puerperal Diseases, p. 34. 

Brunton, Dr. T. Lauder. On the Action of Purgative Medicines. The Practitioner, 
May, 1874. 

Fluckiger and Hanbury. Pharmacographia. Various articles. 

Husemann, Drs. Aug. und Theo. Die Pjlanzenstoffe. 

Husemann, Dr. Theod. Handbuch der gesammten Arzneimittellehre, zweiter Band. 

Kohler, Dr. H. Der Fruchtsaft von Momordica Elaterium in historischer, chemi- 
stJier und physiologischer Hinsicht. Virchow's Archiv, Band xlix., p. 434, ]., p. 273. 

Moreat;, Armand, Dr. Archives Generates de Med., vol. xvi., p. 234, sixth series. 

Percy, Dr. S. R. The American Medical Times, vol. iv. 

Radziejewski, Dr. S. Schmidt's Jahrbucher, vol. cxlvii., p. 20. Zur physiolog. Wir. 
kung der Abfuhrmiltel. 

Rutherford and Vignal. Experiments on the Biliary Secretion of the Dog. Tlie 
British MedicalJournal, November, 1875. 

Thiry, Dr. L. Schmidt's Jahrbucher, vol. exxviii., p. 17. 

Vulpian, Prof. A. Bulletin General de Therap., vol. lxxxiv., p. 522. 

Enemata. — An enema is a rectal injection. The capacity of the 
rectum, it need hardly be stated, varies with the age of the individual. 
For an infant, half an ounce to an ounce; for a child of two to five 
years, two to six ounces ; for five to fifteen years, six ounces to a pint ; 
for an adult, a pint to a quart of fluid may be considered as an ap- 
proximation to the capacity of the rectum at these ages respectiveby. 
Habitual use of injections no doubt increases the tolerance, as also the 
capacity of the rectum. 

Injections may consist of water — cold, tepid, warm, or hot; of medi- 
cated solutions — emollient, anodyne, laxative, cathartic, or anthelmintic. 
Under this head are to be considered only enemata administered with 
the view to cause an evacuation from the intestinal canal. 

Enemata act either by a reflex irritation or by absorption. When a 
cold injection is thrown into the rectum, or tbis organ is distended, an 
action is set up for the expulsion of the offending substance, and the 
muscular fibre of the bowel more or less vigorously contracts according 
to its functional condition. The quantity, as well as the temperature 
of the fluid injected, must therefore be taken into consideration, when 
it is proposed to empty the bowels by a merely reflex irritation. On 
the other hand, when it is the intention to procure the absorption of 
the medicated fluid, the quantity injected must be relatively small, and 
its temperature should as nearly as possible be that of the rectum. In 
order to secure absorption, it is necessary also to regard the laws of 
osmosis. As the secretions of the rectum are alkaline, it is obvious 
that acidulated solutions will diffuse into the rectal veins with the 



CATHARTICS. 581 

greatest facility. It is doubtful whether colloidal substances of them- 
selves are taken up in the rectum. (See Nutrient Enemata, p. 42.) 

Irrigation of the intestines, or forced injections of a large quantity 
of water, is a modern expedient of great practical utility. The appa- 
ratus required for the performance of this operation consists of a rectal 
tube, a flexible rubber pipe three or four feet in length, and a funnel- 
shaped vessel to contain the fluid to be injected. The decubitus on either 
side, the hips being elevated, may be sufficient ; but, to insure gravita- 
tion of the fluid to the ileo-caecal valve, the female patient should be 
placed in Sims's position, and the male patient on his hands and knees. 
The rectal tube should be inserted, and passed up to the sigmoid flex- 
ure ; the flexible tube should then be attached. The height to which 
the reservoir is raised will regulate the hydrostatic pressure, and the 
flow of fluid through the flexible tube can be lessened or increased at 
the pleasure of the operator by compression with the fingers. 

In administering rectal injections the utmost gentleness is requisite, 
especially when a large amount of fluid is to be introduced. Rude 
thrusting of the pipe into the rectum may injure the mucous membrane, 
and rapid and forcible dilatation of the bowel will excite an imperious 
desire to go to stool. Too great pressure, in the process of irrigation, 
may cause a rupture of the intestine, especially if its coats are softened 
by disease or penetrated by ulceration. It is possible that sudden and 
forcible distention of the bowel may produce dangerous cardiac syncope 
in susceptible subjects. 

The experiments on the cadaver have demonstrated that, although 
the large intestine may be filled with water, no fluid can be made to 
pass the ileo-caecal valve. Notwithstanding these experiments, it has 
been claimed that in the living subject, by the irrigation method, water 
can be forced through the whole length of the intestine. If these ob- 
servations are correct, it is probable that a pathological state of the 
ileo-caecal valve must have existed. 

Forms op Enemata. — Enema Aloes. — B« Aloe's, 2>ij ; potassii car- 
bonat., grs. xv ; mucil. amyli vel decoct, hordei, § x. (B. P.) 

Enema Magnesii Sulphatis. — B. Magnesii sulphat., f j; ol. olivse, 
| j ; mucil. amyli vel decoct, hordei, § xv. Dissolve the sulphate of 
magnesia in the mucilage, then add the oil. (B. P.) 

Enema Terebinthinm. — B- 01. terebinthinae, f j; mucil. amyli vel 
decoct, hordei, § xv. (B. P.) 

Enema 01. Ricini et Terebinthinai. — B- 01. terebinthini, §ss; ol. 
ricini, § iss ; ovi, j ; decoct, hordei vel aq. fervid., § xiv. 

A common domestic enema consists of soap-suds, made somewhat 
more stimulating to the rectum by the addition of common salt. 

Therapy. — A pint of cold water is a good enema for cases of 
habitual constipation, especially when there are haemorrhoids which 
bleed with every motion. The enema of aloes, in quantity correspond- 



582 EVACUANTS. 

ing to the age of the subject, is an efficient remedy for the destruction 
of ascarides vermiculares. 

The purgative enemata above given are employed to act on the large 
intestine, chiefly by virtue of reflex stimulation, but, in part, absorption 
of the purgative principle takes place, whence it follows that they may 
affect the whole canal. They are used, therefore, as cathartics, and for 
the ordinary purposes of these remedies. The purgative enemata are 
not suitable for habitual use. They excite irritation of the rectum, 
which may result in ulceration, ischio-rectal abscess, fistula in ano, fis- 
sure of the anus, and other serious accidents. 

Irrigation of the bowel is resorted to for the removal of impacted 
fceces, to overcome intussusception, etc. 

Cases of intestinal invagination have been verj' quickly relieved by 
sudden inflation of the large intestine with carbonic acid. The process 
consists in the injection of a solution of sodium bicarbonate, followed 
by a solution of tartaric acid — about one drachm of each to eight 
ounces of water. The escape of the gas through the sphincter ani must 
be prevented by forcible pressure upon the anus. 

Suppositoria Aloes. — (Aloes and cacao-butter.) Each suppository 
contains about five grains of purified aloes. One of these, introduced 
into the rectum at night, will generally procure one or two evacuations 
on the following day. It is not good practice to employ such a method 
of treatment frequently. 

A piece of hard white soap cut into a conical shape, and of a suit 
able size, is frequently used in domestic practice to relieve the consti- 
pation of infants. The soap suppository thus prepared is carefully 
introduced into the rectum. The habit of a daily evacuation may be 
thus induced. A piece of paper rolled into a conical shape, and dipped 
into oil, may be used instead of the soap suppository. 



ANTHELMINTICS. 

Anthelmintics are remedial agents used to cause the expulsion of 
parasites from the intestinal canal. Vermifuges are remedies which 
expel worms ; vermicides are remedies which kill as well as expel 
worms. Some of these agents act mechanically, as mucuna and pow ■ 
dered tin ; others are administered in such quantity as to sicken and 
disable the worms, when their expulsion is easily effected : for example, 
pumpkin-seed emulsion ; others again possess narcotic and toxic prop- 
erties, as turpentine, chenopodium, santonine, etc. 

Anthelmintics are conveniently divided into those employed against 
ascarides vermiculares, those employed against ascarides lumbricoides, 
and those employed against the different varieties of taenia. 



ANTHELMINTICS. 583 

Ascarides vermiculares infest the rectum and large intestine, ex- 
tending up occasionally as high as the ileo-csecal valve ; in females, 
they may also spread into the vagina. As they deposit their ova in 
the folds of the anus, and in the vagina, it is obvious that the parasiti- 
cide, to be effective, must be applied in these situations. 

Infusion of quassia, decoction of aloes, and a weak solution of car- 
bolic acid, are the most frequently-prescribed remedies for the destruc- 
tion of ascarides. If carbolic acid is used, the strength of the injection 
for children should not exceed twenty grains to the pint. Infusion of 
quassia is at the same time safe and effective ; but, when this injection 
is used, a solution of carbolic acid should be applied also, by means of 
a sponge, to the folds of the anus, and, in the case of female children, 
to the external genitals. If the ascarides extend up into the large intes- 
tine beyond the sigmoid flexure, a dose of santonine and calomel should 
precede the use of the rectal parasiticide. 

REMEDIES USED FOR THE EXPULSION OF ASCARIDES LUMBRICOIDES. 

Mucuiia. — Cowhage. The hairs of the pods of mucuna pruriens. 
(United States Pharmacopoeia secondary list.) This remedy is now 
rarely if ever used. It is administered in the form of electuary, mixed 
with molasses. A teaspoonful or more of the mixture should be ad- 
ministered fasting, and after the action of a cathartic. When several 
doses have been taken a brisk purgative should be given. 

When cowhage is applied to the skin it excites intense itching, in- 
flammation in the skin, and pustulation. It has been proposed as a 
counter-irritant, but a more disagreeable one could hardly be conceived. 
It is very irritant to the intestinal mucous membrane, as it is to the skin, 
and an action is speedily set up for its expulsion. When by the use 
of a purgative, and by reason of fasting, intestinal worms are uncovered 
and exposed to attack, it is held that the mucuna-hairs pierce the para- 
sites and irritate them, so that their stay in the intestine is rendered 
intolerable. In consequence of the active peristaltic movements in- 
duced by the cowhage, and by the purgative with which it is followed, 
the worms are hurried out with the remaining contents, if any, of the 
intestines. 

Santonica. — Santonica. The unexpanded flowers of artemisia cina 
Semencine, Fr. ; Wurmsamen, Ger. 

Composition. — Resin, malic acid, essential oil, and a crystallizable 
principle {santonine). 

Santoninum. — Santonine. " A colorless substance crystallizing in 
shining, flattened prisms, without smell, and nearly tasteless when first 
put into the mouth, and afterward bitter. It is not altered by the air, 
but becomes yellow on exposure to light. Nearly insoluble in cold 



584 EVACUANTS. 

water, it is dissolved by two hundred and fifty parts of boiling water. 
It is soluble in forty-three parts of cold, or in three parts of boiling 
alcohol, and in seventy-five parts of ether." Dose, gr. ss — grs. v, ac- 
cording to age. 

Trochisci Santonini. — Troches of santonine. (Santonine, § ss ; with 
sugar, tragacanth, orange-flower water, to form four hundred and eighty 
troches.) Each troche contains a half-grain of santonine. 

Antagonists and Incompatibles. — We do not possess any satis- 
factory data in regard to the physiological antagonists of santonine. 
When a poisonous dose has been taken the stomach should be emptied, 
and the systemic effects should be treated symptomatically. 

Synergists. — Therapeutically the action of santonine is aided by 
cathartics, especially by calomel. 

Physiological Actions. — In ordinary medicinal doses as used for 
the expulsion of lumbrici, santonine causes no sensible intestinal dis- 
turbance. In considerable doses nausea and vomiting are produced, and 
are followed by colic and diarrhoea. Santonine enters the blood, prob- 
ably, in combination with soda, for, although it has no acid properties, 
it has the power to form such combinations. Santonine, according to 
Hesse (Flilckiger and Hanbury), is the anhydride of a crjstallizable 
acid, which, when heated, is resolved into santonine and water. Vision 
is affected in a remarkable manner. Usually all objects appear as if 
viewed through yellow glass ; but other colors sometimes appear, as 
green, blue, or even red (Gelbsehen, Rose). The chromatopsia is prob- 
ably due, according to Rose, to the solution of santonine in the alkaline 
serum, and its action on the. perceptive centres (vol. xviii., page 26). 
In passing out with the urine santonine imparts a yellowish, and, when 
the amount is large, a reddish-purple, hue to this fluid. 

In toxic doses santonine produces very decided cerebral effects: 
trembling, vertigo, convulsive movements, tetanoid cramps, stupor, 
cold sweats, dilated pupils, insensibility, etc. 

Therapy. — Cures of amaurosis have been reported from the use 
of santonine, but we possess no exact indications for its administration. 
It is, probably, effective only in functional derangement. The chief use 
of this remedy is for the expulsion of ascarides lumbricoides. It is the 
most effective and pleasant remedy which can be employed for this pur 
pose. A convenient form for administration is the troche, or it may be 
prescribed in a powder with calomel. The following is a successful 
plan of using this parasiticide : A laxative in the morning, fasting 
through the day, a dose of santonine and calomel at bedtime, a senna< 
draught on the following morning. 

Authorities referred to : 

Brown, Dr. Dyce. Schmidt's Jahrbucher, vol. el., p. 138. 
Fluckiger and Hanbury. Pharmacographia, p. 347. 



ANTHELMINTICS. 585 

Hermann, Dr. L. Lchrbuch der exper. Toxikologie, p. 383. 
IIusemann, Dks. Auo. und Tiieod. Die Planzensloffe, p. 927. 
Koiilkr, Dit. Hermann. Handbuch, vol. ii., p. 1292. 
Rosk, E. Virchow's Archiv, vols, xvi., xviii., xix., xx., xxviii. 

Spigelia. — Pink-root. The root of spigelia Marilandica. 

Extractum JSpiffelim Fluidum. — Fluid extract of spigelia. Dose 
3 j— I ss. 

Extractum Sennas et JSpir/elice Fluidum. — Fluid extract of spigelia 
and senna. Dcse, 3 ij — S j' 

Infusum Spigelke. — Infusion of spigelia. Dose, § ss — f ij. 

Composition. — A bitter, uncrystallizable principle (spiff elme ?) , vol- 
atile oil, tannic and gallic acid. 

Actions and Uses. — In moderate doses spigelia produces a sensa- 
tion of warmth, at the epigastrium, stimulates the intestinal movements, 
accelerates the action of the heart, and promotes the cutaneous trans- 
piration. In large doses it produces cerebral effects, vertigo, dimness 
of vision, dilated pupils, convulsions, and insensibility. Many of the 
serious symptoms supposed to have been produced by it in certain 
eases, were probably really due to preexisting cerebral lesions. Cases 
of basilar meningitis, for example, have not unfrequently been con- 
founded with " worm-fever." Any vermifuge, given under these cir- 
cumstances, might seem to have caused the head-symptoms which are 
characteristic of the brain-lesions. 

Spigelia is used only as a vermifuge, and against the round worm. 
A low diet and a brisk cathartic should precede the use of this rem- 
edy. The best form for administration is the fluid extract of senna 
and spigelia. 

Authorities referred to : 

Porcher, Dr. F. P. Resources of the Southern Fields and Forests, 
Stille, Dr. Alfred. Tlierapeuiics and Materia Medica. 
United States Dispensatory, thirteenth edition. 

Chenopodium. — Worm-seed. The fruit of chenopodium anthel- 
minticum. 

Oleum Chenopodii. — Oil of worm-seed. Dose, gtt. v — gtt. xv. 

Actions and Uses. — The oil of worm-seed is the only preparation 
of the plant now used, and this is rarely employed, in consequence of 
its very disagreeable and characteristic odor and taste. It excites a 
sensation of warmth at the epigastrium, increases the action of the 
heart, and promotes cutaneous, bronchial, and renal secretions. It is a 
diffusible stimulant, and as such may be given with advantage in hys- 
teria and chorea, as a carminative in flatulence, and as an antiperiodic 
in intermittents. The only use of worm-seed is as a remedy for as- 
carides lumbricoides. It is one of the most efficient of the class. It 



586 EVACUANTS. 

Bhould be given three times a day for two days, and followed by a brisk 
cathartic. An excellent combination for the expulsion of the round 
worm is ten drops of worm-seed oil, and a teaspoonful of fluid extract 
of senna and spigelia. It may also be administered in castor-oil. 

REMEDIES USED AGAINST T^ENI^E 

The success of tasniafuges depends largely upon the preliminary 
treatment. The parasite is imbedded in mucus, its hooklets fixed in 
the mucous membrane. The medicament which is administered for its 
expulsion must come in contact with the scolex. To dislodge a quan- 
tity, however large, of the segments (stroMla), although temporary re- 
lief may follow, will not be permanently curative. The head of the 
parasite must be expelled. 

Before using the taeniafuge the contents of the intestinal canal must 
be thoroughly evacuated. 

Two days of fasting, some milk and bread only being taken, must 
precede the treatment. 

Filix Ma?. — Male fern. " The rhizome, covered with portions of 
the stipes, of aspidium filix mas." Fougere male, Fr. ; Wiirmfam- 
wurzel, Ger. 

Oleoresina Filicis. — Oleo-resin of fern. Dose, 3 ss — 3 ij. 

Composition. — A green, fatty oil, volatile oil, resin, tannin, etc. 
The ethereal extract deposits a granular, crystalline substance (fili- 
cic acid), on which the medicinal activity of the drug appears to 
depend. 

Actions and Uses. — The oleo-resin of filix mas is a very efficient 
remedy for tape-worm, especially the unarmed varietj 7 ; but, if suitable 
precautions be taken to insure success, it is quite a certain remedy for 
the armed taenia. The method of Trousseau and Pidoux is as efficient 
as any (vol. xi., page 1040). On the first day, a strictly milk diet; on 
the morning of the second da}', four grammes (about 3 j) of the oleo- 
resin, in four doses, with an interval of a quarter of an hour between 
each ; on the third day, the same quantity at the same intervals, fol- 
lowed by fifty grammes of the sirup of ether, and, a half-hour later, an 
emulsion containing three drops of croton-oil. Kilchenmeister gives 
a number of methods, and Cobbold favors the employment of male fern 
in certain cases. 

Granati FructllS Cortex. — " The rind of the fruit of punica grana- 
tum." 

Granati Hadicis Cortex. — The bark of the root of punica granatum. 
$corce de racine de grenadier, Fr. ; G-ranatwurzelrinde, Ger. 

Composition. — Pomegranate-bark contains a principle— pelleterine 



ANTHELMINTICS. 587 

— on which its activity depends. The tannate, an efficient taeniaefuge, 
can be given in doses of five grains to one scruple. 

Actions and Uses. — The rind of the fresh root only should be used. 
The best preparation is the decoction, prepared by boiling gently two 
ounces of the bark in a quart of water down to a pint. Of this decoc- 
tion a wineglassful may be given every hour until all is taken. It 
should be preceded by a brisk purgative, arid should be taken fasting. 
It produces more or less nausea, borborygmi, intestinal pain, and usu- 
ally purges. If a purgative effect is not caused by it, a brisk cathartic 
should follow. In the author's experience, this is a very certain and 
efficient taeniafuge. 

Brayera. — Kousso. " The flowers and unripe fruit of brayera an- 
thelmintica." Braylre anthelminthique, Fr. ; JvussoblUthe?i , Ger. 

, Composition. — Brayera contains an active principle (kosine, or Jcous- 
sine), which crystallizes in rhombic prisms. Kosine appears to be inert 
of itself, and is active only when combined with the other constituents 
of the drug. 

Actions and Uses. — Kousso is used solely as an anthelmintic. 
Opinions vary as to its utility. On the whole, it ma) r be said that the 
first enthusiasm which attended its introduction into practice has died 
away. It brings the segments, but rarely expels the head of the para- 
site. It is necessary to take it in large quantity — a half an ounce — 
mixed with water. It is retained with difficulty, and produces much 
intestinal distress. When successful, the worm is brought away with- 
out the action of a purgative. 

Rottlera. — Kameela. "The glandular powder and hairs obtained 
from the capsules of rottlera tinctoria." Dose, 3 j — 3 iij. 

There are no official preparations. A saturated tincture may be 
given, in the dose of one to three drachms. 

Actions and Uses. — It is an orange-powder. It causes some nausea 
and griping, usually, but it may operate without producing any un- 
pleasant sensations. It acts as a purgative, and causes the expulsion 
of the worm. If one dose is insufficient, its administration should be 
continued every three hours until five or six doses have been taken. 
Kameela is effective not only against tapeworm, but also against lum- 
brici and ascarides vermiculares. 

Pepo. — Pumpkin-seed. " The seed of cucurbito pepo." 
Actions and Uses. — This is one of the most efficient remedies which 
we possess against taenia. Two ounces of the fresh seed are pounded 
in a mortar, with a half-pint of water, until the husks are loosened and 
an emulsion is made. The mixture is then strained, and the whole 
amount is taken fasting. If an action of the bowels does not take place 



588 EVACUANTS. 

in two hours, the emulsion should be followed by castor-oil. If success 
is not attained, the dose may be repeated each morning until the para- 
site is produced. Numerous cases of successful use of pumpkin-seed 
emulsion have been reported. 

The expressed oil, which is bland and unirritating like almond-oil, 
may be used as a substitute for the seeds. It should be given in the 
dose of a half-ounce, two or more times, and after several hours fol- 
lowed by castor-oil. The rules already given, in regard to preliminary 
treatment, should also be followed. 

Authorities referred to : 

Cobbold, T. Spencer. On Parasites. Also various articles in The Medical Times and 
Gazette, 187.5. 

Husemann, Dr. Theodor. Handbuch, op. cit., erster Band, p. 202. 

Kohler, Dr. Hermann. Handbuch der physiologische Therapeutik, zweiter Band, 
p. 1292. 

KtrcHENMEiSTER, Dr. Frederick. On Animal and Vegetable Parasites, Sydenham So- 
ciety, vol. i., p. 147, el seq. 

Stille, Dr. Alfred. Tlierapeutics and Materia Medica, vol. ii. 



URINO-GENITAL REMEDIES. 

These remedies are employed chiefly for their action on the genito* 
urinary passages. They stimulate the kidneys to increased activity, 
and excite the functions of the pelvic viscera. In excessive quantity, 
or long continued, they may set up inflammation of the kidney, pro- 
duce strangury and bloody urine, excite uterine contractions, and stimu- 
late to an unnatural degree the sexual propensities. They contain an 
essential oil, or principle, which makes its exit by the urinary passages 
and excites local irritation by direct contact. 

Oleum Terebmthinse. — Oil of turpentine. " The volatile oil distilled 
from the turpentine of pinus palustris, and of other species of pinus." 
Essence, de terebinthine, Fr. ; Terpentinol, Ger. Dose, m. v — 3 ss. 

Iiinirnentum Terebinthince.- — Liniment of turpentine. (Resin cerate, 
I xij ; oil of turpentine, Oss.) 

Antagonists and Incompatibles. — All remedies increasing waste, 
and the vaso-motor depressants, counterbalance the therapeutical ac- 
tions of turpentine. In cases of poisoning the stomach should be 
promptly emptied, and anodynes and demulcents should be adminis- 
tered. Elimination should be favored, and the toxic symptoms treated 
according to the systemic indications. Ozonized oil of turpentine is 
an antidote to phosphorus, preventing the formation of phosphoric acid 
and converting the poison into an insoluble spermaceti-like substance. 
Turpentine worn in a vial about the neck prevents necrosis of the jaw, 



URINO-GENITALS. 589 

and steatosis of organs, in workmen engaged in manufactures employ- 
ing phosphorus. 

Synergists. — The diffusible and alcoholic stimulants favor the action 
of turpentine. 

Physiological Actions. — Turpentine-oil is a limpid, colorless fluid, 
having a strong, peculiar, and diffusive odor, and a hot and pungent 
taste. It is very slightly soluble in water. The oil exposed to the air 
absorbs oxygen (ozone), which it retains with great tenacity. Applied 
to the skin turpentine causes heat, redness followed by a vesicular 
eruption, and sometimes by intractable ulcerations. A few drops pro- 
duce a sense of heat at the epigastrium, and a large dose (medicinal) 
causes intense burning pain, nausea, eructations of the oil, intestinal 
irritation and purging (usually). Notwithstanding its slight solubility 
in water, turpentine diffuses into the blood with facility, and is quickly 
recognized in the breath, sweat, and urine. The action of the heart and 
arteries is increased by it, the arterial tension rises, and a general sense 
of warmth and exhilaration is experienced. In large doses (one or two 
ounces) vomiting, thirst, and a febrile state, are induced ; the muscular 
strength is diminished, the power of coordination is impaired ; exhilara- 
tion of mind, incoherence of ideas, and., rambling insensibility, follow. 
In toxic doses there are complete muscular relaxation and profound in- 
sensibility with abolition of all reflex movements ; the face is flushed 
or cyanosed, the pupils usually dilated, and the breathing labored and 
stertorous. All the organs by which turpentine is eliminated, espe- 
cially the kidneys, suffer from extreme irritation when large doses have 
been swallowed. The skin is usually moist, and exhales a turpentine 
odor ; the bronchial secretion is increased, and convulsive coughing is 
induced; the urine is scanty and bloody, and there is violent strangury. 
The only fatal cases which have been reported have occurred in children 
(Taylor). From four to six ounces have not destroyed life in adults. 

As regards its action on the organs of circulation, the author's ex- 
periments show that turpentine stimulates the vaso-mctor nervous sys- 
tem when administered in moderate doses. A large quantity quickly 
exhausts the irritability of the sympathetic ganglia, the action of the 
heart becomes weak, and the arterial tension falls ; the respiratory 
movements are at first stimulated, but afterward become shallow, and 
carbonic-acid poisoning supervenes. The brains of animals killed by 
turpentine smell strongly of it, and hence it may be concluded that it 
has a direct action on the cells of the cerebral lobes. 

Turpentine has decided antiseptic power. It arrests fermentation 
processes, putrefaction, and is very destructive of minute, organisms 
(vibrio, bacteria, etc.). 

The vapor of turpentine inhaled produces nasal and bronchial irri- 
tation, frontal headache, and renal irritation, even bloody urine and 
strangury. 



590 EVACUANTS. 

On post mortem after turpentine poisoning, violent gastro-intestinal 
irritation, eccliymoses of the air-passages, congestion of the lungs, and 
hyperasmia of the kidneys, are noted. 

Therapy. — Flatulence may be quickly relieved by a few drops 
(three to five) of turpentine, on a lump of sugar. This remedy is es- 
pecially indicated in flatulence persisting from a paretic state of the 
muscular layer of the bowel. There is abundant evidence to prove the 
curative power of oil of turpentine in chronic intestinal catarrh. It is 
especially indicated when the tongue is dry and glazed, when there is 
tympanitic distention of the bowels, and when the alvine discharges 
consist either of fluid feces or scybala, mixed with mucus and pale, 
watery blood. It is best administered in an emulsion, with almond-oil 
and opium. r>. 01. terebinthini, 3 j ; ol. amygdal. express., § ss; tinct. 
opii, 3 ij ; mucil. acacise, 3 v ; aquae laur.-oerasi, § ss. M. Sig. A 
teaspoonful every three, four, or six hours. The same remedy, in a 
similar combination, is very effective in acute dysentery after the sub- 
sidence of the more acute symptoms. The following is probably the 
true explanation of its action in these cases : it gives tonicity to the 
vessels, and to the muscular fibre of the intestines ; arrests the putre- 
factive and fermentative processes which take place in the vitiated 
mucus and articles of food, and increases the cutaneous capillary circu- 
lation, thus relieving congestion of internal organs. 

Stimulating enemata are made of turpentine, mucilage, oils, etc. 
These are especially indicated in constipation, and in impaction of the 
rectum. ]J . 01. terebinthini, 3 ij — § j ; ol. ricini, § ij ; vitell. ovi unius ; 
decoct, hordei, § viij— Oj. M. Sig. As an enema. Such injections 
are frequently used in tympanitic distention of the large intestine, in 
flatulent colic, in impaction of the caecum, etc. 

A combination of equal parts of turpentine and ether constitutes the 
well-known remedy of Durand for the solution and cure of biliary cal- 
culi. Notwithstanding the unquestionable utility of this remedy, we 
cannot admit with Durand that its efficacy depends on its solvent power 
(Trousseau). During the attack of biliary colic this remedy may be 
administered with a view to its anodyne and antispasmodic effect; but, 
as Kohler states, it is by no means equal to morphia and chloral hydrate. 
In the after-treatment, clinical experience is in favor of the occasional 
administration of Durand's remedy during a course of Vichy or Carls- 
bad water. 

Turpentine is one of the most effective remedies which we possess in 
the treatment of taenia?. Full doses ( § ss — f ij ) are required, and the 
rules for preliminary treatment already laid down (see Anthelmintics) 
should be adhered to. Turpentine should be combined with a purga- 
tive, in order to insure prompt cathartic effect. If absorption of any 
considerable part of the turpentine takes place, violent intoxication 
will follow, and irritation of the kidneys, haematuria, and strangury, will 






URIXO GENITALS. 591 

be. produced in the efforts at elimination. The oleo-resin of filix mas 
may be combined with turpentine. I£. 01. terebinthina?, §j; oleo- 
resime filicis, 3 j; vitell. ovi no. ij; ol. riciui, 3 j. M. Sig. A draught. 
This is an effective, but by no means an agreeable, mixture. An ounce 
each of turpentine and castor-oil may be administered, as the cathartic, - 
after the use of the decoction of pomegranate. 

Turpentine being a cardiac stimulant, and an excitant of the capil- 
lary circulation, is contraindicated in hypertrophy of the heart, and 
when advanced atheroma of the cerebral arteries may be presumed to 
exist. It is a serviceable cardiac stimulant when the action of the 
heart is weak, and the arterial tension low. In the passive hosmor- 
rhages we possess few agents more generally useful. The indications 
for its use are a condition of debility, relaxation of the vessels, and an 
impoverished condition of the blood. Transudations of the free mucous 
surfaces — epistaxis, bronchial haemorrhage, hosmatcmesis, intestinal 
haemorrhage, hematuria — when associated with the state of constitu- 
tional depression defined above, are forms of haemorrhage in which 
turpentine should be used. ]J. 01. terebinthinae, 3iij; ext. digitalis 
fl., 3j; mucil. acaciae, |ss; aquae menthae pip., 3 j. M. Sig. A tea- 
spoonfid every .three hours. The haemorrhagic transudations which 
take place in purpura, in scorbutus, and allied states, are also arrested 
by turpentine. It need hardly be stated that active haemorrhage and 
a condition of plethora contraindicate the use of turpentine. 

As a stimulant to the vaso-motor nervous system, turpentine is in- 
dicated in fevers when the action of the heart is feeble, the arterial 
tension low, and the peripheral circulation languid. Ten drops in an 
emulsion is a suitable form, and every two hours is a proper interval 
for its administration in this condition of things. According to (jr. B. 
Wood, a dry tongue, peeling off in flakes, leaving a glazed surface be- 
neath, is a special indication for the use of turpentine in fevers. The 
intestinal haemorrhage of typhoid may be restrained by turpentine. 

Clinical experience is in favor of the use of turpentine in puerperal 
fever, and in yelloio fever. The indications for its employment in 
these maladies are just the same as those mentioned above in typhoid. 
Cardiac weakness, depression of the vaso-motor nervous system, a dis- 
solved state of the blood, are the conditions requiring turpentine. Tym- 
panitic distention of the abdomen is an additional indication in puerperal 
fever. Similarly, turpentine is used in epidemic dysentery, traumatic 
erysipelas, hospital gangrene, etc. In these various states, used with 
a well-defined conception of its real powers, this remedy is more gen- 
erally serviceable as a stimulant than alcohol. As respects the dosage, 
in febrile diseases, a rule may be formulated as follows : for the intes- 
tinal complications, small doses frequently repeated (ten drops) ; as a 
stimulant to the vaso-motor nervous system, larger doses (m. x — 3 ss) 
at somewhat longer intervals. 



592 EVACUANTS. 

In the article on " Phosphorus " attention has been called to the 
utility of turpentine in poisoning by this substance. 

The physiological effects of turpentine indicate its utility in certain 
disorders of the nervous system. As an enema turpentine has been 
used for its derivative effect in insolation or sunstroke (Levick, Wood), 
and in cerebrospinal meningitis (Hirsch). So accurate an authority 
as Topinard maintains the utility of this remedy in the cystic compli- 
cations of posterior spinal sclerosis. Turpentine has long been used 
successfully in epilepsy, but in those cases only in Avhich the seizures 
were due to the reflex impression of intestinal parasites (taeniae). Tic- 
douloureux and sciatica, when rheumatic in origin, or when produced 
by fecal accumulations, have been cured by the vigorous use of turpen- 
tine, but we have now other means of treatment more generally useful 
and less disagreeable. 

As turpentine is largely eliminated by the bronchial and renal mu- 
cous membrane, decided effects are produced at these points. In dif- 
fusing outward, a change in the tonicity of the vessels, and in the 
character of the secretion's, must necessarily be produced. Clinical 
experience confirms the deductions of theory. In chronic bronchitis, 
■with profuse expectoration (bronchorrhcea), especially when the expec- 
torated matters have a fetid odor, turpentine is an excellent remedy 
(Oppolzer). In gangrene of the lung, although it is not curative, it 
acts beneficially in diminishing the fetor. In pneumonia and capillary 
bronchitis, when the vital powers are depressed, and the peripheral 
circulation is feeble, turpentine is one of the best stimulants which we 
can employ. The depression which occurs during the period of crisis 
in pneumonia, and the condition of purulent infiltration, especially in- 
dicate the use of this remedy. In the so-called humid asthma, and in 
emphysema with profuse bronchial catarrh, good results are obtained 
by the use of turpentine. In these various pulmonary maladies, the 
action of turpentine is largely local, as already explained, but it should 
not be forgotten that the powerful stimulation of the cutaneous circu- 
lation which it causes must contribute no small share of the curative 
action. 

In hydro-nephrosis and pyo-nephrosis turpentine is used as in bron- 
chial catarrh, viz., to alter by actual contact the relaxed condition of 
the vessels, and the pathological secretions of the mucous membrane. 
It is of course contraindicated during the existence of acute symptoms. 
Chronic catarrh of the bladder is not unfrequently much improved by 
the use of this agent. It is most serviceable in those cases resulting 
from a transference of urethral inflammation, or due to prostatic dis- 
ease. Incontinence of urine, the result of atony of the muscular layer 
of the bladder, is sometimes removed by small doses of turpentine. 
Chronic gonorrhoea, gleet, spermatorrhoea, and prostorrhoea, when the 
discharges peculiar to these maladies are due to a relaxed condition oi 



URLNO-GENITALS. 59;j 

the affected parts, are not unfrequently remarkably benefited by mod- 
erate doses of turpentine. 

External Uses op Tukpextixe. — The author long ago pointed 
out the fact that turpentine is one of the most efficient applications in 
hospital gangrene. The mortified parts are first removed with the 
scissors, and the remedy is then applied directly to the affected sur- 
face, by means of a piece of cotton cloth saturated with it. Fetor is 
removed and sloughing is arrested, and but little pain attends the 
application. 

Turpentine-stupes are much emploj-ed as a local and external means 
of treating internal inflammations. A piece of spongio-piline, or of 
flannel, large enough to cover the affected part, is first moistened with 
hot water, and then a few drops of turpentine (five to ten drops only) 
are sprinkled on it. As very severe smarting-, inflammation, and vesi- 
cation of the skin may occur from the application, and be experienced, 
indeed, some time subsequently to the removal of the stupe, care must 
be used not to continue it too long. 

Liniment of turpentine is a convenient counter-irritant in cases of 
myalgia, superficial neuralgia, lumbago, etc. An excellent counter- 
irritant application is made by mixing equal parts of oil of turpentine, 
acetic acid, and liniment of camphor (Stille). The most successful 
treatment of severe burns is by the plan of Kentish, which consists in 
first washing the injured surface with turpentine, and then applying an 
ointment made by mixing basilicon ointment with turpentine. Ery- 
sipelas has been treated by the same measures by Meigs, and the same 
applications are generally in use in chilblains. 

Inhalations of turpentine-vapor, or atomized turpentine, is an efficient 
means of local treatment in chronic laryngeal and bronchial affections. 
As a matter of curious therapeutics, it may be mentioned that gonor- 
rhoea has been successfully treated by requiring the patient to inhale 
the vapor of turpentine. 

Authorities referred to : 

Bartholotv, Dr. Roberts. The Cincinnati Lancet and Observer, October, 1864. 

Da Costa, Dr. J. M. The American Journal of the Medical Sciences, January, 1866. 

Levick, Dr. R. J. The American Journal of the Medical Sciences, January, 1S69. 

Little, Dr. Tlie Practitioner, vol. ix., p. 369. 

Oppolzer, Prop. AUgem. Wiener med. Zeit., No. xxxiii., 1866. 

Stille, Dr. A. Therapeutics and Materia Medica, vol. ii., p. 753. 

Topinard, Dr. L. De V Ataxic Locomotrice, etc., Paris, 1864. 

Trousseau, Dr. A. Clinique Midicale de V Hotel Dieu. 

Trousseau et Pidoux. Traite de Therap. el de Maliere Medicate, vol. ii., p. 802. 

Wood, Dr. George B. TJie Practice of Medicine, fourth edition, vol. i., p. 346. 

Wood, Dr. H. C. American Journal of the Medical Sciences, October, 1863. 

Copaiba. — Copaiba. " The oleo-resin of copaifera multifuga, and of 
39 



594 EVACUANTS. 

other species of copaifera." JBaume de copahu, Fr. ; Copaiva-Balsam, 
Ger. Dose, m. x — 3 j- 

Pilulce Copaiboe. — Pills of copaiba. (Copaiba, § ij ; magnesia, 3 j.) 

Oleum Copaiboe. — Oil of copaiba. Dose, m. v — 3 ss. 

Composition'. — Balsam of copaiba differs from the true balsams in 
not containing cinnamic acid. It is an oleo-resin, the volatile oil con- 
stituting from forty to sixty per cent. The oil of copaiba is isomeric 
with the oil of turpentine, but it differs in some of its physical prop- 
erties from the latter. The resin has an acid reaction, and has been 
entitled copaivic acid. 

Actions and Uses. — Copaiba has a nauseous, bitter, and very dis- 
agreeable taste. When taken into the stomach it causes some heat, 
and offensive eructations, tasting of the balsam, occur. Indigestion, 
heaviness at the epigastrium, anorexia, are frequently produced by it, 
and diarrhoea is an occasional result of its use. It is, therefore, a gas- 
trointestinal irritant. Both the oil and the resin diffuse into the blood. 
The various excretions, the sweat, the bronchial mucus, the urine, ac- 
quire a peculiar and rather a fragrant odor from its presence. This odor 
is especially observable in the urine, and in this secretion the resin may 
be discovered also by the addition of nitric acid, which causes a precipi- 
tate. At the points of elimination more or less irritation is produced, 
and, as a result of the irritation, increased secretion ; hence copaiba is 
said to be diaphoretic, diuretic, and expectorant. Very serious injury 
may be done to the gastro-intestinal canal, and to the kidneys, by the 
use of this agent in large doses. The author has known gastro-intes- 
tinal catarrh to persist many months after a course of balsam, and he 
has reason to believe that desquamative nephritis and fibroid kidney 
have resulted from its free administration for a lengthened period. 
While small doses of balsam* will increase the gross amount of urine 
and of the solid contents, large doses will actually cause a diminution 
in the amount both of water and solids by setting up renal irritation. 
Although, during a course of balsam, nitric acid causes a precipitation 
of the resin, which is dissolved on the addition of alcohol, the author 
has, in several instances at least, detected albumen in the urine of those 
taking this remedy. 

Copaiba is contraindicated when a condition of gastro-intestinal irri- 
tation and hyperaemia of the kidneys exist. 

Gonorrhoea is the disease to which copaiba is most especially 
adapted. Its administration should not be begun, however, until after 
the acuter symptoms have subsided. As the action of the remedy is 
local or direct, acute symptoms are rather aggravated by it. Combina- 
tion with liquor potassae promotes its curative action by diminishing 
the acidity, and hence the irritation produced by the urine. Combina- 
tion with agents acting synergistically, as oils of cubebs and sandal- 
wood, is also desirable. The following formulas exemplify these thera- 



URINO-GENITALS. 595 

peutical facts: IJ. Copaibae, pulw cubebae, aa, |ij; aluminis, 3J; opii, 
gr. v. M. Sig. One to two drachms, night and morning. IJ. 01. 
copaibae, ol. cubebae, ol. santal. flaw, aa 3 j ; magnesiae, 3 ij- M. ft. pil. 
no. lx. Sig. Two pills every four hours. 

In chronic catarrh of the bladder, copaiba is useful by virtue of the 
local action which it has upon the mucous membrane. Its nauseous 
taste and the gastric and renal irritation produced bj r it are serious ob- 
jections to its use in a malady which requires the persistent and long-con- 
tinued application of remedies in order to even moderate its symptoms. 

For acute bronchitis after the subsidence of the fever, for chronic 
bronchitis with profuse secretion, for bronchorrhoea (dilated bronchi), 
copaiba is the most generally serviceable expectorant. Unfortunately, 
it is so disagreeable that it is difficult to overcome the repugnance of 
patients. Even when administered in capsules, or in pill-form with 
magnesia, the nauseous eructations excite disgust. IJ . Copaibae, bal- 
sam, tolutan., pulw acaciae, aa 3 ss ; acid, sulphur, aromat., 3 ss ; aquae 
destil., 3" vj. M. Sig. A tablespoonful, two or three times a dag, in 
chronic bronchial affections, whooping-cough, etc. IJ . Copaibae, syrp. 
tolutan., aa, |ss; aquae menthae pip., § ij ; spirit, etheris nitrosi, § j. 
M. Sig. A teaspoonful every four hours. 

Excellent results have been obtained from the use of copaiba in 
dropsy, especially in ascites. In these cases it acts powerfully on the 
kidnej-s. Wilkes holds that copaiba-resin is a more efficient diuretic 
than the balsam. IJ. Res. copaibae, 3 iij ; alcohol., 3v; spirit, chloro- 
formi, 3 j ; mucil. acaciae, § ij ; aquae ad 3 xij. M. Sig. A tablespoon- 
ful ter in die. 

In some subjects possessed of an irritable skin, copaiba produces an 
eruption of urticaria, or roseola, or erythema. This is not in conse- 
quence of a selective action on the skin, but is the result merely of the 
gastro-intestinal disturbance. Influenced, probably, by this fact that 
an eruption may be caused by copaiba, this agent has been proposed as 
a remedy in certain cutaneous diseases, those characterized by torpor 
of the peripheral circulation. 

Authorities referred to : 

Bernatzik, Prof. Dr. W. Prag. Vjhrschr., c, p. 239. Sch.rn.idCs Jahrbikher, voL 
cxli., p. 278. 

Fluckiger and Hanbury. Pharmacographia, p. 200, et seq. 

Gubler, Dr. A. Commeniaires Therapeutiques, p. 86, et seq. 

Husemann, Dr. Theodor. Handbuch, p. 1195, et seq. 

KShler, Dr. Hermann. Handbuch, erste Halfte, p. 370, et seq. 

Trousseau et Pidoux. Traile de Therap. et de Matiere Medicate, vol. ii. 

Weikart, Dr. H. Axchiv der Heilk., i., ii., p. 176, 1860. Schmidt's Jahrbiicher, vol 
cvi, p. 162. 

Wilks, Dp. & The Lancet, 1873, vol. i., p. 410. 



596 • EVACUANTS. 

Cllbeba. — Cubeb. " The unripe fruit of cubeba officinalis (Miquel), 
piper cubeba (Linn.)." Cubbbes, Fr. ; Cubeben, Ger. 

JSxtractum Cubebce Fluidum. — Fluid extract of cubeb. Dose, 3 ss 

— 3ij. 

Oleum Cubebce. — Oil of cubeb. Dose, m. v — 3 ss. 

Oleoresina Cubebce. — Oleo-resin of cubeb. Dose, m. v — 3 ss. 

Tinctura Cubebce. — Tincture of cubeb. Dose, 3 ss — 3 ij. 

Trochisi Cubebce. — Trocbes of cubeb. 

Composition". — Cubeb contains a volatile oil which varies in propor- 
tion from six to fifteen per cent. It is polymeric with oil of turpen- 
tine. This volatile oil separates in the cold into two distinct substances 
— a camphoraceous substance (cubebene), and a liquid portion (cubeben). 
Besides these, a neutral crystallizable principle (cubebin) has been iso- 
lated. Cubeb also contains a resin, divisible into two distinct sub- 
stances, an indifferent portion and an acid (cubebic acid). The thera- 
peutical properties of the drug reside chieflj 7 , if not exclusively, in the 
oil and resin, hence the oleo-resin is an efficient preparation. 

Actions and Uses. — The taste of cubeb is aromatic, pungent, and 
somewhat camphoraceous. In the stomach it excites a sensation of 
warmth, and, in moderate doses, promotes the appetite and the diges- 
tive capacity. In considerable doses it is laxative, and produces a feel- 
ing of heat and irritation about the rectum. Ingested in a large quan- 
tity cubeb sets up a gastro-intestinal catarrh, and may even cause acute 
inflammatory symptoms. , The active principles diffuse into the blood. 
The action of the heart and vascular system is increased by cubeb, the 
surface becomes warm and perspiring under its use, and the bronchial 
and urinary secretions are more abundant. The odor of cubeb is im- 
parted to the breath and to the urine, and the resin may be precipi- 
tated from the urine by the addition of nitric acid. As explained in 
the previous article (Copaiba), the resin precipitated by nitric acid re- 
sembles albumen, but differs from the latter substance in being soluble 
in alcohol. 

Cubeb stimulates the venereal appetite in man, and promotes the 
catamenial flux in women. 

Finely-powdered cubeb is an efficient local application in chronic 
nasal catarrh. It is blown into the nares by an insufflator. It gives 
considerable relief also in hay-asthma, when there is no fever, and the 
secretion of the nasal mucous membrane is profuse and watery. Pow- 
dered cubeb is useful as a topical application when the mucous mem- 
brane of the fauces is relaxed, or the seat of chronic inflammation (fol- 
licular pharyngitis). The officinal cubeb-troches are employed by 
singers and public readers, to maintain the tonicity of the mucous mem- 
brane and to prevent or relieve hoarseness. 

Cubeb may also be used, in small doses, to promote secretion and 
increase digestion in cases of atonic dyspepsia. Chronic catarrh of the 



URIXO -GENITALS. 597 

colon and rectum, with a relaxed condition of the mucous membrane 
and of the inferior hemorrhoidal vessels, may be removed by cubeb. 
Sometimes these cases take the form of a mucous dysentery. 

The most important application of cubeb is in the treatment of 
gonorrhoea. Unlike copaiba, it may be administered with good effect 
during: the acute stage. The best results are obtained from a mixture 
of the two agents. Catarrh of the bladder, prostorrhoea, spermator- 
rhoea, are maladies in which cubeb may be employed with more or less 
advantage. When the sexual appetite is weak, and the erections feeble, 
cubeb will sometimes, if the troubles are functional, remove them. 

Irritability of the bladder, nervous or functional in character, espe- 
cially as it occurs in women, is generally relieved by cubeb ; but can- 
tharides is a more efficient remedy for this troublesome affection. 

In chronic bronchial affections, with profuse expectoration, cubeb 
has a remedial effect similar to that possessed by copaiba, and is useful 
under the same conditions. 

Piper. — Black pepper. "The unripe berries of piper nigrum." 
Poivre noir, Fr. ; Schwarzer JFfeffer, Ger. 

Composition. — Pepper contains a resin and an essential oil, and a 
neutral crjstallizable principle (piperine). 

Oleoresina JPiperis. — Oleo-resin of black pepper. This contains the 
active constituents of pepper, and is an eligible preparation. Dose, 
m. j — m. v. 

Capsicum. — Capsicum. " The fruit of capsicum annuum, and of 
other species of capsicum." Poivre d'Inde, Fr. ; Spanischer JFfeffer, 
Ger. 

Composition. — The acrid, pungent qualities of capsicum are due to 
a peculiar substance (capsicine), a thick, yellowish-red liquid. Felletar, 
whose observations have been confirmed by Fliickiger, has isolated a 
volatile alkaloid having the odor of coniine. 

Ttfusum Capsici. — Infusion of capsicum ( § ss — Oj ). 

Oleoresina Capsici. — Oleo-resin of capsicum. Dose, m. j — m. v. 

Tinctura Capsici. — Tincture of capsicum. Dose, m. x — 3 j. 

Actions and Uses. — Notwithstanding black and red pepper be- 
long to different orders, they are closely related therapeutically and in 
their physiological actions. They may with propriety be considered 
together. 

"When applied to the skin, pepper excites redness, heat, and super- 
ficial inflammation. Red pepper, if in contact with the skin a sufficient 
length of time, will produce vesication. It also causes great irrita- 
tion of the mucous membrane. It has a hot, pungent, and rather 
acrid taste, and increases the flow of saliva. In the stomach a sensation 
of warmth is produced by it, the secretions are more abundant, di- 



598 EVACUANTS. 

gestion is more active, and the appetite is promoted. In an excessive 
quantity gastritis may be produced. The intestinal secretions are no 
doubt increased, and the alvine evacuations rendered more easy and 
copious. 

The action of the heart and arteries is increased by pepper, a sub- 
jective sensation of warmth is experienced throughout the system, and 
cutaneous transpiration becomes more abundant. Elimination takes 
place chiefly through the kidneys. The flow of urine is increased, mic- 
turition is more frequent, and more or less vesical tenesmus occurs. 
Decided aphrodisiac effects are produced by red pepper. 

The tincture of capsicum may be usefully employed as a stomachic 
in atonic dyspepsia. It is especially indicated in the dyspepsia of 
chronic alcoholism, when there are present trembling and insomnia. 
Flatulent colic may be relieved by capsicum, especially when this dis- 
order occurs in h\'sterical subjects. The author has seen excellent re- 
sults from the use of this remedy in the dyspepsia and flatulence of 
hypochondriacal subjects, and of women at the climacteric period. 

Capsicum is an excellent addition to beef-tea when this aliment is 
administered in fevers, and other low conditions of the system. The 
tincture may be employed under the same circumstances as a cardiac 
stimulant. 

The evidence is conclusive that capsicum quiets restlessness, and 
induces sleep in delirium tremens. It may be administered mixed with 
beef-tea or other animal broths, or thirty grains made into a bolus, 
with sirup or honey, may be given. As capsicum belongs to the family 
Solanaceas, and as Felletar discovered in it a volatile alkaloid, a rational 
explanation is afforded of its action on the cerebrum. According to 
Ringer, the tincture of capsicum is the best substitute for the stimulant 
when an attempt is made to break the alcohol-habit. It is also very 
serviceable in the treatment of the opium-habit. The good effect of 
the remedy in these cases is in part due to its action as a stomachic 
stimulant, and partly, doubtless, to its cerebral effects. 

The oleo-resins of black and red pepper have been usedwith good 
results in the treatment of intermittent fever. They are useful chiefly 
as adjuvants to more efficient remedies. 

Capsicum is contraindicated in all acute affections of the genito- 
urinary apparatus. In chronic parenchymatous nephritis it checks the 
waste of albumen. In chronic pyelitis, chronic cystitis, and pi'ostor 
rhoea, it has a beneficial effect ; but, although similar in action to, it is 
less efficient than cubeb. Excellent results are often obtained from it 
in functional impotence, and in spermatorrhoea from deficient tone. In 
these genito-urinary maladies, the oleo-resin is the best preparation for 
administration. R. Oleoresinas capsici, 3j; ergotini (aq. ex.), 3ij. 
M. ft. pil. no. xx. Sig. One three times a day. 

A capsicum-plaster is a mild counter-irritant. The infusion is em- 



URINO-GENITALS. 599 

ployed as a gargle in tonsillitis, diphtheria, and scarlet fever. As it is 
a very irritating application, its use should be restricted to cases char- 
acterized by a low grade of action. 

Junipems. — Juniper. "The fruit of juniperus communis." JBaies 
de genievre, Fr. ; Wachholdcrbeeren, Ger. 

Infusum Juniperi. — Infusion of juniper ( 3 j — Oj ). Dose, § ss — 

Sij- 

Oleum Juniperi. — Oil of juniper. Dose, m. v — m. xx. 

Spiritus Juniperi Compositus. — Compound spirit of juniper. (Oil 
of juniper, 3 jss ; alcohol, Ov ; water, Oiij ; oils of caraway and fennel, 
each m. x.) Dose, \ ss — | j. 

Composition. — Juniper contains a volatile oil, upon which its me- 
dicinal effects chiefly depend. A non-crystallizable principle (juni- 
perine) exists in the berries in very small quantity. It contains also 
formic, acetic, and malic acids. 

Actions and Uses. — Juniper increases the appetite and digestion, 
but in overdoses will disorder the stomach. The volatile oil diffuses 
into the blood with facility. Increased action of the heart and of the 
arteries, a subjective sensation of warmth, diaphoresis, and diuresis, are 
produced by it. 

The oil is eliminated by the kidneys chiefly, and imparts an odor of 
violets to the urine. It powerfully stimulates the renal functions, and 
in large doses causes strangury and bloody urine. It may set up a 
high degree of irritation of the kidneys, leading to suppression and 
uraemic intoxication. In common with the other remedies of this group, 
juniper excites the venereal appetite, in large doses may cause pria- 
pism, and in women promotes the menstrual flow. 

The principal use of juniper is as a diuretic. It is contraindicated 
in acute affections of the kidneys. It is largely employed as a diuretic 
in cardiac and renal dropsy. The infusion is an excellent vehicle for 
the exhibition of saline diuretics in these affections. The oil of juniper 
acts similarly to, and is indicated under the same conditions as, turpen- 
tine in chronic pyelitis, chronic cystitis, gleet, prostorrhcea, etc. Diu- 
retic effects may be obtained by inhalation of the vapor of the oil. For 
this purpose a few drops may be put into hot water, and the vapor be 
inhaled. 

The empyreumatic oil of juniper (oleum cadinum), obtained by de- 
structive distillation from juniperus oxycedrus, is a thick, black liquid, 
similar in appearance to and smelling like common tar. It is much 
employed as a local application in chronic eczema, impetigo, ichthyosis, 
psoriasis, acne rosacea, etc. It is usually combined with German soft- 
soap. IJ. Alcoholis, saponis mollis, ol. cadini, aa § j ; ol. lavendulae, 
3 jss. M. ]J. 01. juniperis empy. (ol. cadini), saponis mollis, aa § j ; 



600 EVACUANTS. 

ol. lavend., 3 ss. M. Sig. Ointment. ]J. 01. juniperis empy., 3j — 
§ j ; sevi, 3 ss ; adipis, § j. M. Sig. Ointment. 

Erigeron. — Erigeron. "The leaves and tops, of erigeron heterophyl- 
lum, and of erigeron Philadelphicum." 

Erigeron Ganadense. — Canada erigeron. 

Oleum Erigerontis Canadensis. — Oil of Canada erigeron. Dose, 
m. v. — m. x. 

Actions and Uses. — Erigeron possesses a diuretic property to a slight 
extent. Canada erigeron is the more active, and contains a much larger 
proportion of volatile oil. The actions and uses of the oil are the same 
as the oil of turpentine, but the latter is the more efficient remedy. 
The oil of Canada erigeron has a local reputation in Philadelphia as an 
haemostatic agent. It is said to be effective in menorrhagia, and cases 
of intestinal haemorrhage arrested by it have been reported. It is 
adapted only to the treatment of passive haemorrhages, and is probably 
less curative than turpentine in these cases. 

BuclM. — Buchu. " The leaves of barosma crenata and of other spe- 
cies of barosma." Feuilles de bucco, Fr. ; Pukublatter, Ger. 

Infusum JBuchu. — Infusion of buchu ( § j — Oj). Dose, § ss — § ij. 
Extractum JBaehu Fluidum. Fluid extract of buchu. Dose, m. x 

-3j. 

Composition. — Buchu contains a volatile oil in the proportion of 
about 1.5 per cent. This volatile oil consists of a crude oil and a cam- 
phor — barosma camphor. The latter has a nearly pure peppermint 
odor. The existence of barosmine, so called, is doubtful. 

Uva Ursi. — Uva ursi. " The leaves of arctostaphylos uva ursi." 
Feuilles de busserole, Fr. ; JBcirentraubenblatter, Ger. 

Deeoctum Vvos Ursi. — Infusion of uva ursi (§j — Oj). Dose, 3 ss 

Extractum Uvoe Ursi Fluidum. — Fluid extract of uva ursi. Dose, 
3 ss— 3 ij. 

Composition. — Uva ursi contains a bitter, neutral, crystallizable 
substance, arbutine ; a very bitter amorphous principle, ericoline / and 
a tasteless, crystallizable, neutral principle, ursone. It is rich in gal- 
lic and tannic acids. 

Pareira. — Pareira brava. " The root of cissampelos pareira." Ha ■ 
cine de pareira-brava, Fr. ; Grieswurzel, Ger. 

Infusum Pareirce. — Infusion of pareira brava ( § j — Oj). Dose, 
1 ss— I ij. 

Extractum Pareira?, Fluidum. — Fluid extract of pareira. Dose 
3 ss— 3 ij. 



URINO-GENITALS. G01 

Composition. — It contains a principle, luxine, but it is not known 
whether this is the active ingredient. 

Chimaphila. — Pipsissewa. " The leaves of chimaphila umbellata." 
Decoctum Chimaphila}. — Decoction of chimaphila. Dose, 3 ss — 

3 j j- 

Extractum Chimaphilce Fluidum. — Fluid extract of chimaphila. 

Dose, 3 ss — 3 ij. 

Composition. — Pipsissewa contains a crystallizable principle, chi- 
maphiline, tannic acid, extractive matters, etc. 

Scoparius. — Broom. " The tops of sarothamnus scoparius. Genet d 
balais, Fr. ; Pfriemenhraut, Ger. 

There are no preparations officinal to the United States Pharmaco- 
poeia. A decoction and fluid extract corresponding to those above 
mentioned may be employed. 

Composition. — Scoparius contains an indifferent or somewhat acid 
crystallizable principle, scoparine, and an oily, colorless, liquid alkaloid, 
sparteine. The latter has very decided basic qualities, and agrees 
with coniine and nicotine in being constituted without oxygen. 

Actions and Uses. — Buchu, uva ursi, pareira, pipsissewa, and sco- 
parius, form a group of diuretics with properties in common. They are 
tonic, astringent diuretics. They promote appetite and digestion, and 
restrain intestinal movements, except pareira, which has rather a laxa- 
tive action. Their active constituents diffuse into the blood and are 
eliminated by the kidneys. In passing over the genito-urinary tract 
these principles act topically upon the mucous membrane. As a rule 
they are actively diuretic ; that is, they increase the amount of urinary 
water. Pipsissewa and scoparius are rather more actively diuretic than 
buchu and uva ursi, and hence are more useful in dropsy. By English 
physicians generally, and notably the late Dr. Pereira, scoparius is held 
in much esteem as a remedy for dropsy. It is adapted especially to 
the treatment of cardiac dro})sy, and the general anasarca of chronic 
parenchymatous nephritis, but is inadmissible in acute affections of 
the kidney. Our indigenous remedy, pipsissewa, may be substituted 
for scoparius in the treatment of dropsy. 

Buchu, uva ursi, and pareira, are more particularly useful in chronic 
pyelitis, catarrh of the bladder, chronic gonorrhoea, etc. ; and of these 
the most efficient, probably, is buchu. The fluid extract is the most 
eligible form in which these remedies can be administered. 



= 



Carota. — Carrot-seed. " The fruit of daucus carota. The wild-car- 
rot." 

The seeds of carrot have a hot, pungent, and bitter taste, due to a 
volatile oil which they contain, and to which their medicinal activity is 



602 EVACUANTS. 

due. As they impart their virtues to water, an infusion of the seeds 
is an eligible form in which to administer the remedy. Carrot-seeds 
act similarly to juniper, and produce diuresis, augment the menstrual 
flux, and cause aphrodisiac effects in the male. 

Taraxacum. — Dandelion. " The root, gathered in the autumn, of 
taraxacum dens-leonis." Pisserilit, Fr. ; Lbwenzahnwurzel, Ger. 

Extractum Taraxaci. — Extract of taraxacum. Dose, gr. v — 3j. 

Infusum Taraxaci. — Infusion of taraxacum (' § ij — Oj). Dose, 
1 ss— 1 ij. 

Extractum Taraxaci Fluidum. — Fluid extract of taraxacum. Dose, 

3j-?j- 

Composition. — According to Kromayer, taraxacum contains tarax- 
acine, an amorphous, intensely bitter principle, and a crystalline sub- 
stance, taraxacerine. Nothing is definitely known as to the action of 
these substances. 

Actions and Uses. — Taraxacum possesses the properties of a sim- 
ple bitter, in that it promotes the appetite and digestion. It has been 
long held, both popularly and professionally, to possess the power to 
promote the flow of bile. Recent investigations have demonstrated 
the inaccuracy of these opinions. It is a mild laxative, and as such, 
doubtless, may cause by reflex stimulation an emptying of the gall- 
bladder. It is a diuretic, although not a very active one. It is still 
prescribed as a laxative in catarrhal jaundice, in ascites from hepatic 
disease, and in dyspepsia and indigestion associated with torpor of the 
liver. By German physicians, muriate of ammonia and dandelion are 
frequently associated together in the treatment of the affections above 
named. Taraxacum is occasionally used as a diuretic in dropsy, but its 
utility is very limited. 

The fluid extract of taraxacum is a good vehicle for the administra- 
tion of such remedies as the muriate of ammonia and quinia, the taste 
of which it somewhat covers. 

Scilla. — Squill. " The bulb of scilla maritima." Ognon marin, 
Fr. ; Meerzwiebel, Ger. . 

Acetum Scilla}. — Vinegar of squill ( f iv — Oij). Dose, m. xx — 3 j. 

JPilhda? Scilla} Composite. — Compound pills of squill (squill, gin- 
ger, ammoniac, soap). Each pill contains half a grain of squill and 
one grain of ammoniac. Dose, one pill three or four times a day. 

Syrupus SciUa?. — Sirup of squill. Dose, 3 ss — 3 j. 

Syrupus Scillm Compositus. — Compound sirup of squill. Hive- 
sirup. This preparation contains squill, senega, and tartar - emetic, 
the last named in the proportion of one grain to the ounce. Dose, 
m. v — 3 j. This is a very active preparation, due chiefly to the tartar- 
emetic. 






UMNO-GENITALS. C03 

Tinctura Scillce. — Tincture of squill. Dose, m. v — 3 ss. 

Composition. — The important constituent of squill is an acrid, bit- 
ter principle, scillitine, or skulel'n — which has not yet been isolated. 
According to Schroff, scillitine is a 'glucoside, and the active principle 
is an acrid, non-volatile substance (Flllckiger and Hanbury). 

Actions and Uses. — The taste of squill is bitter and somewhat 
acrid. It is an irritant to the mucous membrane, and excites nausea, 
vomiting, and purging, when introduced into the stomach in a sufficient 
dose. Very violent gastro-enteritis may be produced by its incautious 
administration in large doses. A state of hypersemia or inflammation of 
the gastro-intestinal mucous membrane, therefore, contraindicates its use. 

The active constituents of squill diffuse into the blood. Its systemic 
effects are produced by application to the external integument. Pa- 
ralysis and convulsions are induced in warm-blooded animals by toxic 
doses ; and similar cerebral symptojhs occur in man, in addition to the 
phenomena which usually attend the action of an irritant poison. In 
ordinary medicinal doses squill increases the bronchial mucus and facili- 
tates expectoration. In toxic doses rapid breathing has usually oc- 
curred. It is highly probable that a portion of the active constituents 
of squill is eliminated by the broncho-pulmonary mucous membrane. 

■Squill stimulates the functions of the kidneys and increases the 
urinary discharge when used in medicinal doses, but in excessive quan- 
tity it excites violent inflammation, with strangury and bloody urine. 
Suppression of urine may be a result of its irritating action on the kid- 
neys. 

The use of squill is confined to its expectorant and diuretic effects. 
The acetum and syrupvs scillce enter into the composition of expec- 
torant mixtures employed in the treatment of catarrh of the bronchial 
tubes, after the subsidence of acute symptoms and the chronic forms of 
the disease. Squill is more particularly indicated when the sputa are 
tenacious and are coughed up with difficulty. Ipecacuanha is advanta- 
geously combined with it in the more recent cases. $. Acet. scillie, § ss ; 
extract, ipecac, fluid., 3 ss ; tinct. opii deod., 3 j ; syrp. tolutan., 3 x. 
M. Sig. A teaspoonful every two, three, or four hours. T},. Scillae, 
ipecac, aa, gr. vj ; ext. hyoscyami, gr. iij ; morphioe sulph., gr. ss — gr. j. 
M. ft. pil. no. xij. Sig. One pill every four hours. In chronic bron- 
chitis with emphysema or dilated right cavities of the heart, squill is 
better associated with the stimulating expectorants, ammoniac, asafce- 
tida, benzoin, etc. IJ . Syrp. scillae, § ss ; tinct. opii camphor., 3 ij ; 
ammoniac, 3 ss ; syrp. tolu., 3 x. M. Sig. A teaspoonful as neces- 
tary. Squill is an improper remedy when there are present fever and 
an acute inflammatory condition of the air-passages. 

Squill is a very effective diuretic. Since in overdoses it will pro- 
duce great irritation of the kidneys, it is inadmissible in acute affec- 
tions of these organs. In dropsy caused by any of the chronic dis« 



604 EVACUANTS. 

eases of the kidneys, squill must be used with caution. As a diuretic 
this remedy is more especially useful in cardiac dropsy. It may be 
combined with digitalis or the saline diuretics. r£. Infus. digitalis, 

1 iijss ; acet. scilke, § ss. M. ' Sig*. A tablespoonful two or three times 
a day. IJ. Digitalis, 3j ; scillae, gr. x ; ext. colchici acet., 3j. M. ft. 
pil. no. xx. Sig. One pill every four or six hours. When anaemia is 
present, iron may be added to the above formula. 5, . Acet. scillae, 

§ ss ; liq. potassii citratis, § iijss. M. Sig. A tablespoonful every four 
hours. 

Authorities referred to : 
Eluckiger and Hanbokt. Pharmacographia. 
Husemann, Dr. Theod. Handbuch, zweiter Band, p. 1175. 
Kohler, Dr. Hermann. Handbuch, p. 615. 

Petroselinum. — Parsley-root. " The root of petroselinum sativum." 

Composition. — The most important constituent of parsley is apiol, 
an oily, non-volatile, yellowish liquid, having a distinctive odor and an 
acrid taste. It contains, also, a gelatinous substance, apiine (pectin ?), 
and a volatile oil. 

Actions and Uses. — Petroselinum has a hot, pungent taste, with 
an after acrid sensation. It is somewhat laxative — a property, doubt- 
less, dependent on the irritation which it produces. It is stimulant in 
its effects on the circulation, and promotes the cutaneous and bronchial 
secretions. It is diuretic, by reason of the local irritant action of the 
principles which are eliminated by the kidneys. 

Apiol has decided properties, and in its action strongly resembles 
quinia. It produces headache, tinnitus aurium, vertigo, intoxication, etc. 

Petroselinum is rarely employed for its diuretic effects. Its use is 
indicated in dropsy under the same conditions as juniper, squill, and 
other stimulating diuretics. It may be given in the form of infusion 
( § j — Oj), one to three ounces at each dose. 

Apiol is a remedy of considerable value in the treatment of mala- 
rial diseases, but it is inferior in every respect to quinia. Its use is 
only justifiable in the treatment of intermittens, and when the preju- 
dices or idiosyncrasies of the patient forbid the use of quinia. Fifteen 
grains should be administered in one dose, or in divided doses, within 
an hour, in order to procure the maximum effect, and about four hours 
previous to the paroxysm. 

The evidence is conclusive ^that apiol has decided emmenagogue 
power. It is a stimulant to the uterine system, and therefore is con- 
traindicated in plethora of these organs, and should not be adminis- 
tered as an antiperiodic to pregnant women. It is indicated when a 
state of torpor of the ovaries and uterus exists. The amenorrhcea of 
anaemia, of functional inactivity, is the form of the malady in which 
apiol is serviceable. The condition of the blood should be corrected 



URINO-GENITALS. 605 

by iron, constipation should be removed by aloetic purgatives, and the 
apiol, iu a considerable dose (fifteen grains), should then be adminis- 
tered at the time of the menstrual molimen, or just preceding the time 
when the flow should begin. If the case has been obstinate, a daily 
dose of apiol may be given for a week, or at least for several days be- 
fore the menstrual period. The neuralgic form of dysmenorrhoea is 
also benefited by this remedy. Other neuralgice are, it is said, relieved 
by apiol, but the existence of a malarial cause is, no doubt, the expla- 
nation of its curative action in such cases. 

Authorities referred to : 

Delorme, Dr. Gazette des Hopitaux, 1860, p. 511. 

Joret and Homolle. Bulletin General de Therapeutique, vol. xlviii., p. 32. 

Marotti, Dr. Ibid., 1863, p. 295. 

Stille, Dr. A. 2'kerapeulics and Materia Medica, vol. ii., p. 631. 

United States Dispensatory, thirteenth edition, article Pelroaelinum. 

Polygonum Hydropiperoides. — Water-pepper. This indigenous plant 
is not recognized by the United States Pharmacopoeia. A fluid extract 
prepared according to the general directions of the United States Phar- 
macopoeia may be prescribed in the dose of m. x. to 3 j. A solid ex* 
tract is also to be found in the shops — dose, gr. j — gr. v. 

Actions and Uses. — The taste of hydropiper is hot, pungent, and 
acrid. The juice excites inflammation and vesication when applied to 
the external integument. In medicinal doses it causes a sensation of 
warmth in the stomach, and a " peculiar tingling sensation throughout 
the whole system " (Eberle). Unless given in an overdose it does 
not excite vomiting or produce purging. It stimulates the heart and 
arteries, increases the •warmth of the surface, and promotes the cuta- 
neous, bronchial, and renal secretions. It promotes the menstrual flow, 
and is aphrodisiac. 

This indigenous but little known remedy is a very efficient stimu- 
lating diuretic and emmenagogue. The author can confirm the state- 
ment of Eberle, who reports that " with no other remedy or mode 
of treatment has he been so successful as with this," in amenorrhoea. 
It is adapted to cases of amenorrhoea due to functional inactivity or 
torpor of the uterine system, and is contraindicated when a condition 
of plethora or congestion • exists. The administration of this remedy 
should be begun about a week before the menses ought to appear. 
Thirty minims of the fluid extract should be administered four times a 
day. If anaemia exist, iron should be given ; if constipation, aloes. 

Hydropiper is a remedy of considerable power in functional impo- 
tence. When the erections are feeble, the seminal fluid watery, and the 
testes soft, good results will be obtained from the use of this remedy, 
provided no structural alterations hinder or prevent improvement. 



006 EVACUANTS. 

When hydropiper is administered in these disorders of the sexual 
system, it causes a feeling of weight and tension, and dragging of the 
pelvic viscera. As it tends to increase the blood-supply to these organs, 
it is inadmissible when a state of congestion or inflammation exists. 

Authorities referred to : 

Eberle, Dr. John. A Treatise of the Materia Medica and Therapeutics, fourth edi- 
tion, vol. i., p. 441. 

Porcher, Dr. C. Peyre. Resources of the Southern Fields and Forests, p. 409. 
United States Dispensatory, thirteenth edition, p. 1540. 

Ruta. — Rue. " The leaves of ruta graveolens." 

Composition. — The medicinal activity of this plant depends on the 
presence of a volatile oil. Only the fresh leaves should be employed, and. 
as drying impairs the quality of the drug, the oil should be prescribed. 

Oleum JRutdB. — Oil of Rue (unofncinal). This is a volatile oil, of 
a greenish-yellow color, very disagreeable and characteristic odor, and 
pungent, acrid taste. Dose, m. j — m. v. 

Actions and Uses. — In its local action rue is an irritant ; applied 
to the skin, the oil causes heat, inflammation, and vesication. In ordi- 
nary medicinal doses a sensation of warmth follows its introduction into 
the stomach, and increased action of the heart and arterial system and 
a subjective feeling of peripheral heat are subsequently produced. The 
cutaneous, bronchial, and urinary excretions become more abundant, 
and the odor of the volatile oil is apparent in the breath, the sweat, and 
the urine. In toxic doses the oil of rue produces violent gastroenteri- 
tis, prostration, convulsive muscular movements, hebetude of mind, etc., 
strangury and suppression of urine. In women the use of rue increases 
the menstrual flow, and large doses may cause abortion to take place. 
In men this agent promotes the sexual appetite, and increases the vigor 
of the erections. 

A tincture of the oil of rue is an efficient carminative and antispas- 
modic remedy in the flatulent colic and hysteria of women. Almost 
the only use of rue at present is in the treatment of amenorrhoea. It 
is one of the most efficient emmenagogues. Plethora, congestion, or 
inflammation of the pelvic viscera, contraindicates its use. Functional 
inactivity of the ovaries and uterus is the condition which justifies the 
employment of rue. It has been recommended in menorrhagia when 
the vascular tonus is low, and in uterine haemorrhage after miscarriage. 
It need hardly be remarked that the condition of pregnancy forbids 
the use of rue. 

Sabilia. — Savine. " The tops of juniperus sabina." Sabine, Fr. ; 
SdbenJcraut, Ger. 

Composition. — Savine contains an essential oil, in the proportion of 
two to two and a half per cent, in the tops and about ten per cent, in 
the berries. The oil of savine is isomeric with the oil of turpentine. 



UMNO-GENITALS. 607 

Oleum Sabince. — Oil of savine. Dose, m. j — m. v. 

JEjxtractum Sabince Fluidum. — Fluid extract of savine. Dose, m. 
v — m. xv. 

Actions and Uses. — Savine lias a strong, disagreeable odor, and a 
pungent, acrid taste. Applied to the skin the oil causes inflammation 
and vesication, if the contact be sufficiently prolonged. Introduced 
into the stomach in a full medicinal dose, a sensation of heat, eructa- 
tions tasting of the oil, flatulence, and nausea, are produced. A toxic 
dose sets up a violent gastro-enteritis. The oil diffuses readily into 
the blood, and is excreted by various channels — the breath, the sweat 
and the urine, smelling strongly of it. Increased action of the heart 
and a rise of tension of the arterial system, followed by diminished 
tonus of the vessels, result from its administration in full medicinal 
doses. The cutaneous, bronchial, and urinary excretions are rendered 
more abundant by savine. Strangury and bloody urine are caused by 
it in overdoses. The evidence is conclusive that savine exerts a pow- 
erful influence on the uterine system. It increases the menstrual flux, 
and in toxic doses may originate uterine action and cause abortion. The 
abortifacient effect cannot be obtained unless by the administration of a 
quantity sufficient to endanger life. 

The only use to which savine is now applied is in the treatment 
of amenorrhea. It is generally conceded that the estimate of its pow- 
ers made by Pereira is not extravagant, namely, that " it is the most 
certain and powerful emmenagogue of the whole materia medica." 
Savine is indicated in amenorrhcea dependent on deficient activity of 
the sexual system, accompanied by general atony. It is inadmissible 
when a tendency to congestion of the pelvic viscera is present, or in a 
condition of general plethora. Cases of dysmenorrhcea are benefited 
by savine when the subject is of relaxed habit, the menstrual flow be- 
ing scanty, provided narrowing of the cervical canal is not the cause 
of the painful and difficult menstruation. Menorrhagia, when due to 
an enlarged, relaxed, and passively congested uterus, and haemorrhage 
after abortion, may sometimes be arrested by this agent. 

The most effective preparation of savine is the oil. This may be 
prescribed in gelatine-capsules, in an emulsion, or in pillular form. The 
fluid extract, if made from the fresh tops, is an excellent preparation. 
Combination with other remedies of the same group increases the action 
of savine. $. . 01. sabinae, 3 j ; ol. rutas, 3 j ; tinct. polygon, hydropi- 
per, | j ; ol. amygdal. express., mucil. acacias, aqua? menth. pip., aa 3 ij- 
M. Sig. A teaspoonful twice or three times a day as an emmenagogue. 

Authorities referred to : 

Aran, M. Bulletin General de Therapeulique, vol. xxx., p. 61. 

Beau, M. Le Dr. Ibid., vol. xliii., p. 140. 

FLrrciUGER and Hanbury. Pharmacographia. 

IIusemann, Dr. Theodor. Handbuch, zweiter Band, p. 1200. 



C08 EVACUANTS. 

KonLER, Dr. Hermann. Handbuck, p. 38V. 

Taylor, Dr. A. S. On Poisons, third edition, London, p. 494. 

Van de Warker, Dr. Ely. The Detection of Criminal Abortion, 1872. 

Cantharis. — Cantharides. Cantharis vesicatoria. Cantharide, Fr. ; 
SpaniscJie Fllegen, Ger. 

Tlnctura Cantharidis. — Tincture of cantharides. Dose, m. ij — m. xv. 

(The other preparations of cantharides, which are used externally 
only, will be taken up in Part III. of this work.) 

Composition. — The principal constituent of cantharides is a neu- 
tral, crystallizable principle, cantharidine. It contains also an oil, 
fatty matter, and an odorous material. 

Antagonists and Incompattbles. — There is no chemical or physio- 
logical antagonist to cantharides. Poisoning by this substance should, 
therefore, be treated on general principles. The stomach should be 
evacuated by emetics or the stomach-pump ; mucilaginous substances 
should be freely administered; the gastro-enteritis should be treated 
by opium, etc. 

Synergists. — Oils and fats increase the solubility and favor the 
absorption of cantharidine. The physiological actions of this agent are 
promoted by the other agents of this group. 

Physiological Actions. — The odor of cantharides is nauseating, 
fetid, and peculiar. In contact for a sufficient time with the skin or 
mucous membrane, it excites considerable burning, inflammation, and 
vesication. In the stomach it causes a sensation of heat, severe gas- 
tralgia, nausea, and vomiting. Notwithstanding the insolubility of 
cantharidine, it readily diffuses into the blood. It is actively stimulating 
to the circulatory system, and a rise of temperature, with thirst, follows 
in an hour or two. Under these circumstances, the Urine becomes 
scanty and burns the passages ; severe pain is experienced in the back 
and loins ; priapism occurs ; and the urine, voided with great difficulty, 
frequently contains albumen and blood. To this excitement of the 
circulatory system and of the genital organs succeeds a condition of 
depression, in which the pulse falls, the arterial tension is lowered, and 
the temperature declines (Radecki). 

When a toxic dose is swallowed, in a short time a sense of constric- 
tion of the oesophagus, with difficulty of swallowing, and ptyalism, occur. 
Intense gastric pain, vomiting of glairy mucus streaked with blood, in- 
testinal pain, abdominal tenderness, tenesmus, and mucous and bloody 
stools, are produced. Violent irritation of the genito-urinary organs is 
also experienced, manifested by lumbar pain, strangury and bloody 
urine, priapism, swelling and inflammation of the external genitals. In 
most cases of poisoning by cantharides, cerebral effects, consisting of 
muscular trembling, partial or general convulsions, coma, and insensibil- 
ity, are produced. Abortion has been caused by toxic doses of can- 
tharides, and after death violent metro-peritonitis, gastro-enteritis, and 



URINO-GENITALS. 609 

general peritonitis have been observed. It is questionable whether 
abortion can be caused by a dose less than dangerous. 

Cantharides has frequently caused dangerous symptoms, when used 
with a view to induce venereal excitement. That it does promote the 
sexual appetite is probably true, but this result is accomplished only by 
the use of a quantity sufficient to cause vascular turgescence of the 
sexual organs. 

Therapy. — In acute desquamative nephritis, after the subsidence 
of the acuter symptoms, good results are obtained from cantharides. 
The local condition in which this remedy is serviceable consists in 
hyperemia with loss of vascular tonus. Chronic 2>yelitis and chronic 
catarrh of the bladder are occasionally remarkably benefited by the 
long-continued use of small doses of cantharides. Irritability of the 
bladder, more especially as it occurs in women, without the existence 
of acute inflammation, and not produced by uterine displacements, is 
sometimes quickly and entirely relieved by this remedy. The irritable 
state of the bladder and the vesical tenesmus, which accompany chronic 
prostatic disease, are also sometimes surprisingly relieved by canthari- 
des, but the author is unable to indicate the special circumstances to 
which it is adapted. 

Gleet and prostorrhcea are benefited by cantharides when these 
maladies occur in subjects of a relaxed fibre, with feeble circulation. 
Ringer makes the extraordinary statement that one drop of the tincture 
given three times a day will prevent chordee. 

When spermatorrhoea actually exists, and is due to deficient tone of 
the seminal vesicles, the erections being feeble, and the sexual feeling 
torpid, good results are obtained by the use of cantharides. In cases 
of scanty menstruation, occurring in women of lax fibre, with cold 
hands and feet, improvement follows the use of this remedy. It some- 
times happens that menorrhagia is due to relaxed vessels and a general 
lowering of the vascular tonus : under such circumstances cantharides 
may render important service. In these disorders of the sexual system, 
characterized by deficient power, the good effects of cantharides are 
promoted by the use of iron. The tincture of cantharides is the most 
eligible preparation for internal administration. In chronic affections 
of the genito-urinary passages the dose will range from two to five drops 
— rarely the latter — three times a day. 

Authorities referred to : 

Casper's Practisches Handbuch der gerichtlkh.cn Medicin, by Liman, zweiter Band, 
p. 576. 

Husemann, Dr. Theod. Handbuch, zweiter Band, p. 538, et seq. 

Radecki, Fr. Die Cantharidinvergiftung. Inaug. Diss. Schmidt's Jahrbucher, vol 
cxxxviii., p. 17. 

Ringer, Dr. Sydney. Handbook of Therapeutics. 

Taylor, Dr. A. S. On Poisons, fourth edition, London, p. 624. 
40 



PAET III. 
TOPICAL REMEDIES. 



COUNTER-IRRITANTS. 

External irritation, utilized for the relief or cure of internal 
maladies, is entitled counter-irritation. The remedies employed for 
this purpose are divisible into two groups : 

1. Rubefacients ; 

2. Epispastics. 

A rubefacient is a remedy which causes heat and redness ; but, if 
the contact with the skin be sufficiently prolonged, vesication may be 
produced. An epispastic is a remedy which excites inflammation and 
vesication. The first group of remedies are restricted in. their applica- 
tion to such therapeutical results as can be attained by a superficial and 
temporary action in the skin. The second group are intended for 
more permanent action and a deeper impression on internal organs. 
These remedies differ not only in the degree, but in the character of 
the effects produced. An impression on the periphery induces some 
kind of molecular modification at the centre. According as the im- 
pression is slight or severe are the centric modifications localized to 
the point of reception or transferred to distant points (reflex impres- 
sions). According to the severity of the peripheral impression are the 
resulting local centric disturbance and the reflex changes (tropic alter- 
ations). Thus a slight peripheral rubef action may cause a trivial cen- 
tric vascular spasm, but an extensive burn on the body may cause 
destructive ulceration of the duodenum. 

RUBEFACIENTS. 

Sinapis Alba. — White mustard. " The seed of sinapis alba." 

Sinapis Nigra. — Black mustard. " The seed of sinapis nigra." 

Charta Sinapis. — Mustard-paper. 

Composition. — When water is added to pulverized black mustard, 
pungent, irritating fumes are given off. These fumes consist of the 
volatile oil of mustard (allyl sulphocyanide). This volatile oil is pro- 
duced by a reaction between certain constituents of the seeds — sini- 
grin (myronate of potassium) and myrosin — in presence of water, and 



RUBEFACIENTS. Gil 

at a temperature below 100° Fahr. The boiling-temperature destroys 
the ferment, myrosin, and hence prevents the formation of the volatile 
oil. Mustard contains also a bland fixed oil, which may be procured 
by expression. 

AVhite mustard contains an indifferent, crystalline substance, sinal- 
bin, and myrosin. Sulpho-cyanate of acrinyl, a product of the reac- 
tion between sinalbin and myrosin, is the rubefacient principle of white 
mustard (Fllickiger and Hanbury). White mustard contains also an 
alkaloid — sinapine. The chemical compositions of the two kinds of 
mustard are, it will be seen, closely analogous. ' Myrosin exists in white 
mustard in larger proportion than in black, hence a considerably larger 
quantity of the volatile oil of mustard is formed, when an addition of 
white mustard is made to the black. 

JEmplastrum Arnicce. — Plaster of arnica (extract of arnica, resin- 
plaster). 

JEmplastrum JPicis JBurgimdicce. — Burgundy pitch-plaster (Bur- 
gundy pitch, yellow wax). 

JEmplastrum JPicis Canadensis. — Canada pitch-plaster (Canada 
pitch, yellow wax). 

JEmplastrum JPicis cum Cantharide. — Plaster of pitch with can- 
tbarides (Burgundy pitch, cerate of cantharides). 

JLinimentum Ammonia. — Liniment of ammonia (water of ammonia, 
3J; olive-oil, I ij). 

JLinimentum Camphorce. — Liniment of camphor (camphor, § iij ; 
olive-oil, § xij). 

JLinimentum Saponis. — Soap-liniment (soap, 3 iv ; camphor, § ij ; 
oil of rosemary, fss; water, § vj ; alcohol, Oij). 

JLinimentum Terebinthinai. — Liniment of turpentine (resin-cerate, 
3 xij ; oil of turpentine, Oss). 

JFiring. — The application of heat by Mayer's hammer. 

An excellent rubefacient for long-continued use and moderate activ- 
ity is the domestic spice-bag. This consists of a mixture in equal parts 
of cloves, cinnamon, allspice, ginger, and a half-pint of capsicum, sewed 
into a flat bag. When required for use, it is dipped in vinegar or 
whiskey, and laid over the affected region, usually the abdomen. A 
piece of flannel or spongio-piline may be moistened with the tincture 
of these aromatics, and applied for the same purposes. 

A turpentine-stupe, which is one of the most frequently-used extem- 
poraneous counter-irritants, is made as follows: A piece of flannel 
folded in several layers, or a piece of spongio-piline, is wrung out in 
hot water, and a few drops (five to fifteen) of turpentine are sprinkled 
over it. This is placed over the affected region, and is confined by a 
towel or napkin pinned around the part. Turpentine, applied in this 
way, is a very active rubefacient, and may even vesicate, so that atten- 
tion is required to avoid overaction. 



612 TOPICAL REMEDIES. 



EPISPASTICS. 



Ceratum Cantharidis. — Cantharides or blistering cerate. 

Ceratum JExtracti Cantharidis. — Cerate of extract of cantharides. 

Gharta Cantharidis. — Cantharides-paper. 

Collodium cum Cantharide. — Collodion with cantharides. 

Linimentum Cantharidis. — Liniment of cantharides. (Turpentine 
and cantharides.) 

Of the above preparations the most efficient is the ceratum extracti 
cantharidis, the most elegant the charta cantharidis, and the most 
convenient the collodium cum cantharide. The cerates should be 
spread on adhesive plaster, leaving a margin of the plaster to secure 
adhesion to the skin. Before the application of a blister, if prompt 
action is necessary, a mustard-plaster should be laid on long enough to 
produce rubefaction, or the skin should be rubbed with turpentine. 
When the skin is very thin and sensitive, the blister should be covered 
with tissue-paper. When the vesication is to be permitted to heal in 
a short time, or when young and irritable subjects are to be blistered, 
the cantharides-plaster should be removed when distinct redness of the 
skin is produced, and a poultice applied, which will develop the vesi- 
cles. The length of time required for a blister " to draw " is influenced 
by the age of the subject and the condition of the skin. From two to 
twelve hours, as a rule, will elapse before vesicles appear ; and, when a 
very deep impression is intended, the blister may remain even twenty- 
four hours. In infants and in certain states of the constitution (scor- 
butus, purpura, scarlatina, .etc.), prolonged contact of a cantharides- 
plaster may cause deep sloughing and very severe nervous sj'mptoms, 
and adynamia. 

When the vesicles are fully developed, they should be punctured at 
the most dependent point, and the serum, as it escapes, absorbed by a 
soft cloth. If the blistered surface is to be allowed to heal, a dressing 
of raw cotton suffices. If discharge is to be encouraged, resin-cerate 
or savine-cerate may be applied spread on a cloth perforated to permit 
the discharge to exude and covered with raw cotton to absorb the fluid . 
If the blister is slow to heal, boracic-acjd lotion is an efficient applica 
tion, or a weak lead-lotion may be used. 

The Theory oe Coitoter-Ieritation. — When the skin is irritated, 
by a mustard-plaster, for example, the superficial vessels of the part 
dilate, and an increased amount of blood is present in them. For a 
short distance around the part irritated, also, more or less dilatation of 
the vessels takes place. In this way a small amount of blood may be 
temporarily imprisoned. The influence which the retention in an ex- 
ternal part of so small an amount of blood has, on the general circulation, 
must be very slight. The obvious relief often afforded by a mustard-plas- 
ter can hardly, therefore, be ascribed to .this limited withdrawal of blood. 



EPISPASTICS. G13 

An irritation established in the neighborhood of a part in which a 
morbid action is proceeding may, by reason of the contiguity of the 
tissues, affect the vascular supply to the diseased textures. TJbi irri- 
tatio, ibi fluxus / but, in order that the fluxion shall modify diseased 
action, it is necessary that there be a continuity of the vascular con- 
nections. The method of Furneux Jordan, which consists in the appli- 
cation of the counter-irritant to the neighboring vascular area, is based 
on this principle. 

An irritation which consists in a local fluxion, and a state of altered 
sensibility in the nerves of the part, may affect the functions of distant 
organs. Counter-irritation applied to a considerable surface increases 
the action of the heart, raises the temperature of the body, and exalts 
the irritability of the nervous system. These are the general or sys- 
temic effects. Distinctly-localized results are also produced. When 
one hand is immersed in cold w r ater, a positive fall of temperature takes 
place in the other. Irritation of the lumbar region, as Brown-Sequard 
has shown, is followed by contraction of the vessels of the kidneys. 
Extensive injury to the surface of the body, by burning or scalding, 
may excite ulcerative action in the duodenum, or may set up a pneumo- 
nia. Injury to a motor-nerve trunk may be followed by ascending neu- 
ritis, and serious atrophic changes in the multipolar ganglion-cells of 
the anterior columns. — It follows from these facts that an irritation of 
the surface which involves the end-organs of the nervous system will 
affect the calibre of the arterioles and modify the functions of the trophic 
nerves. In these results we find a rational explanation of the methodus 
medendi of counter-irritation. 

Certain other physiological laws deserve attentive consideration in 
this connection. An irritation which first produces a tetanic state of 
the vaso-motor nervous system may, if too long continued, exhaust the 
irritability of the organic muscular fibre, and cause paresis. Moderate 
irritation will exalt the functional power of the trophic centres ; but 
excessive and long-continued injury to the surface may set up atrophic 
changes (ulcer of duodenum from burn). In these physiological facts 
also we find a rational explanation of the injury not unfrequently done 
by too powerful or too protracted counter-irritation. 

Vesicants, in addition to the effects of counter-irritants sketched 
above, cause an exudation of serum. This exudation may have a two- 
fold effect : 1. To lessen the gross amount of the blood-serum, and thus 
diminish the blood-pressure ; and, 2. To remove toxic or pathological 
materials from the tissues and fluids of the inflamed part. More 
powerful systemic effects are produced, and vaso-motor paresis and 
trophic changes are more quickly induced by blisters than by rubefa- 
cients. 

Therapy. — Various methods of counter-irritation are employed in 
the treatment of diseases of the abdominal viscera. For the relief of 



614 TOPICAL REMEDIES. 

nausea, vomiting, diarrhoea, colic, cholera-morbiis, etc., no expedient is 
more generally useful than a mustard-plaster. In persistent vomiting, 
a small blister applied to the epigastrium will often afford permanent 
relief. The good effects of a blister in such cases are enhanced by dust- 
ing over the exposed derma some powdered morphia. In acute inflam- 
matory affections — typhlitis, p>eritonitis, puerperal peritonitis, pelvic 
cellulitis, etc. — the best results are obtained by the use of turpentine- 
stupes during the acute stage, and the application of blisters after the 
acuter symptoms have subsided. The prolonged contact of blisters 
with the abdominal wall of thin subjects has set up peritonitis by con- 
tiguity of structures. The author has observed instances of this kind, 
and analogous cases have been reported. 

In chest-diseases — pleuritis, pneumonia, pericarditis,- etc. — some 
form of counter-irritation is invariably employed, and is often greatly 
abused. At the onset of these maladies a large mustard-plaster to the 
chest, allowed merely to redden the skin, is an excellent expedient ; 
during the progress of the inflammation the turpentine-stupe is gener- 
ally the best application ; to assist in the process of resolution and re- 
pair, the more permanent action of a blister will be serviceable. Much 
has been said about the " blistering-point " in pneumonia. The discus- 
sion is resolvable into this : during the inflammatory stage, blisters are 
harmful, because they stimulate the nervous and vascular system, and are 
useful when the crisis occurs, to assist in the liquefaction and absorption 
of inflammation products. At the very inception of an acute thoracic 
disease a flying blister may render the same service as a mustard-plas- 
ter, but it possesses no advantage over the latter. A succession of 
" flying blisters" appears to be useful in hydrothorax, to promote ab- 
sorption. 

Counter-irritants are much abused in the treatment of phthisis at its 
various stages. The chest-pains which accompany this disease can 
usually be relieved by mustard and belladonna plasters. Intercurrent 
attacks of pleuritis and pneumonia may be treated by the milder forms 
of irritation. The pustulation of the chest with croton-oil or tartar- 
emetic ointment is rarely if ever justifiable, and deep blistering is al- 
ways harmful. 

In acute inflammation of the meninges, cerebral or spinal, blisters 
are often employed, but there is singularly little proof of their utility 
When used they should be confined to the mastoid processes or to 
the nape of the neck. Under no cii cumstances is it ever justifiable to 
shave and blister the scalp, as was formerly not unfrequently done in 
various forms of cerebral disease. An aura proceeding from an ex- 
tremity may be intercepted, and attacks of epilepsy averted, by encir- 
cling the limb with a strip of blistering-plaster. Various instances of 
the success of such a blister have been reported. Hysterical paraly* 
sis is most successfully treated by encircling the affected extremity 



EPISPASTICS. G15 

with narrow blisters (Reynolds), and hysterical aphonia may some- 
times be very quickly cured by a blister to the larynx. The curative 
effect of such an application is doubtless due to the moral impression 
of the counter-irritant. Blisters over the course of the affected nerve 
are of great service in neuritis. The good effect of the blisters is in- 
creased by treating the blistered surface with morphia. There can be 
no doubt of the curative value of blisters in neuralgia?. According to 
Anstie, it is not the mental impression produced by the pain of the 
blister, and not the withdrawal of serum from the focus of pain, which 
explain their efficacy, but they act " as true stimulants of nerve-func- 
tion." The best point at which to apply the blister is " as close as may 
be to the intervertebral foramen from which the painful nerve issues." 
Flying blisters are to be preferred, and, as a rule, exudation of serum is 
not to be encouraged. 

Lumbago, myalgia, and fugitive but recurring muscular pains, are 
sometimes relieved by the warming plasters given at the head of this 
article, or by frictions with ammonia-liniment, turpentine-liniment, etc. 

Blisters are, as a -rule, inadmissible in acute affections of the kid- 
neys and bladder. A succession of blisters to the perinseum is un- 
questionably serviceable in chronic prostatitis and in gleet. 

Inflammatory affections of the eye and ear are, as a .rule, bene- 
fited by the application of blisters in the neighborhood of these or- 
gans. 

The application of blisters is an effective method of treating acute 
rheumatism. According to the plan of Davies and Dechilly, the 
affected joints are enveloped in blisters, which are allowed to remain 
until thorough vesication is produced and serum is abundantly dis- 
charged. The author, who has had considerable experience in the 
treatment of rheumatism by this method, finds that a number of small 
blisters applied around the joint are as effective and less painful. The 
good effects of the blister-treatment are these : the pain and swelling 
are abated, the danger of cardiac complication lessened, and the dura- 
tion of the disease shortened. It is a singular fact that the urine be- 
comes neutral or alkaline under the action of blisters. The curative 
effect of blisters is not, probably, to be ascribed to the withdrawal of 
acid serum from the affected joints, but rather to an influence exerted 
through the trophic nerves on the metamorphosis of tissues. 

As general stimulants, rubefacients and vesicants are employed to 
arouse the vital processes in a condition of great depression or col- 
lapse from any cause, e. g., cholera, pernicious malarial fever, urmmia, 
narcotic poisoning, etc. 

Contraindications op Blisters. — The acute stage of an inflam- 
mation ; pregnancy ; scorbutus and purpura ; infancy ; debility. 

The strangury produced by blisters is lessened by the free use of 
diluent drinks, and is relieved when it occurs by an enema of laudanum 



61 G TOPICAL REMEDIES. 

or the hypodermatic injection of a minute quantity of morphia. A 
decoction of uva-ursi freely drunk "will, it is said, prevent strangury, 
but the effect of this remedy is, probably, not greater than that of an 
ordinary diluent. 

The method of " firing " is sometimes very beneficial in neuralgia, 
spinal irritation, myalgia, etc. The effects can be regulated by the 
temperature of the hammer, and by the duration of the contact with 
the skin, and may vary in severity from the mildest rubefaction to 
vesication, and even destruction of the skin. 

Acupuncture. — Needles about three inches in length, and having 
a red wax, hard-rubber, or metal head, are employed for this purpose. 
They are introduced by a rapid rotatory motion. Insulated needles 
are used in the same way for conveying the galvanic current to deeply- 
placed nerves. 

Baunscheidtismus. — This is a form of acupuncture, so named from 
Baunscheid, its inventor. " The instrument employed consist's of a 
heavy disk, about half an inch in diameter, having inserted into it 
about twenty-five sharp needles, each about nine-sixteenths of an inch 
in length. To this disk a strong wire spiral spring (five and a half 
inches in length) is attached, and the other extremity of the spring is 
inserted into an elongated spindle-shaped handle." The spring and 
needles are contained in a cylinder, the handle attached. The following 
is the mode of using it : the open- extremity of the cylinder is placed 
firmly on the skin ; the handle is then drawn up which compresses the 
spring; now, if suddenly loosed, the recoil of the spring drives the 
needles smartly into the skin. The punctures may be rubbed with a 
weak mixture of croton-oil, with cajeput-oil, or other suitable counter- 
irritant. 

Actions and Uses. — These are methods of counter-irritation which 
appear to possess peculiar powers. The theories which have been 
proposed to explain their mode of action are far from satisfactory. The 
method of Baunscheid is that of an ordinary counter-irritant added to 
the effects of acupuncture ; but no explanation has hitherto been offered 
which accounts, in a rational manner, for the curative effects of acu- 
puncture in certain maladies. 

In tic-douloureux, sciatica, lumbago, and myalgia, it occasionally 
happens that remarkable and instantaneous relief is obtained by the 
insertion of acupuncture-needles. 

When the patient is timid, the sensibility of the skin may be di- 
minished by the application of chloroform for a minute, or of the ether- 
spray. If rapidly rotated by the finger and thumb, the needle will 
penetrate with little suffering. 

Aquapunctube. — The method of aquapuncture consists in the in- 
troduction of water subcutaneously, or into the substance of muscles. 
A special instrument has been invented for this purpose, the advantage 



AQUAPUNCTURE. G17 

of which consists in its being armed with several needles, which per- 
mit the introduction of the water at various points simultaneously. 
Ordinarily, the hypodermic syringe will suffice for the performance of 
this little operation, and, if patients object to repeated punctures, the 
sensibility of the skin may be obtunded by ether-spray. 

When water is injected under the skin, more or less pain, accompa- 
nied by burning, is produced. A wheal is formed about the site of the 
puncture, and redness of the skin and elevation of the temperature at 
that point follow. It is a remarkable circumstance that aquapuncture 
has the power to relieve pain in a superficial nerve. So decided is this 
effect that there are physicians who hold that the curative effect of the 
hypodermatic injection of morphia is due, not to the morphia, but to 
the water ! In order that aquapuncture shall relieve pain, it is neces- 
sary that the water be injected into the neighborhood of the painful 
nerve. Injection at a remote and indifferent point would certainly fail 
of any effect except that reflex effect which is produced by any coun- 
ter-irritant. Aquapuncture, however, has unquestionable power as a 
counter-irritant. 

The method of aquapuncture has been employed with success, which 
must be regarded as extraordinary in neuralgia?, facial, sciatic, and 
lumbo-abdominal ; in lumbago, irritability of the bladder, uterine colic, 
gastralgia, etc. The author has produced excellent effects from the in- 
jection of water into paralyzed and wasting muscles. It promotes the 
nutrition of muscles, and contributes to the regeneration of voluntary 
power. In the various cases to which this treatment is applicable, the 
quantity which should be injected will vary from thirty minims to a 
drachm. When the first injection does not relieve in two minutes, 
another should be practised. It is insisted upon (Lafitte) that the 
water be injected at the painful points {points douloureux). There 
need be no limit to the number of the injections, if they afford relief; 
for, of course, no injury will result unless it be the occasional produc- 
tion of an abscess at the site of the injections. 

Authorities referred to : 

Anstie, Dr. F. E. On Neuralgia and the Diseases that resemble it, London and New 
York, 1871, p. 192, et seq. . 

Ibidem. The Practitioner. On the Theory of Counter-Irritation, vol. iv., p. 156. 

Bennett, Dr. James Risdon. Remarks on Counter-Irritation. The Practitioner, vol. 
il, p. 321. 

Daties, Dr. Herbert. TJte Lancet, vol. ii., 1865. 

Dickinson, Dr. TV. H. On the Practice of Counter-Irritation. • The Practitioner, vol 
iil , p. 97. 

Dieulafot, Dr. Geor&es. Nov. Diet, de Med. et de Chirurg. Prat., article Douleur, 

Lafitte, Dr. Leopold. Z' Union Medicale, October 5, 1875. 

Delct, Dr. Ibid. 

Ross, Dr. James. On Counter-Irritation. Tlie Practitioner, vol. iv., p. 78. 

Sbrvajan, Joannes. De V Aquapuncture, Paris, 1872, pp. 56. 



618 TOPICAL REMEDIES. 



BLOODLETTING. 



Venesection, arteriotomy, cupping, leeching. — The manner of bleed- 
ing, whether by opening a vein or an artery, is a surgical subject, which 
it is not necessary to consider in this work. 

Physiological Actions. — Bloodletting may be employed for a sys- 
temic or local effect. Bleeding from a vein or an artery, by diminish- 
ing the whole quantity of the circulating fluid, and by altering its 
quality, affects the functions of every organ, and especially of organs 
the seat of an acute hyperemia. Cupping and leeching, if carried far 
enough, may diminish the general blood-pressure and the proportion of 
the morphotic elements ; but their action is largely local and revulsive. 

The effects of blood-letting on the composition of the blood are 
these : the water is increased and the globules, fibrine, and salts, are 
diminished in relative amount ; an artificial ansemia is thus induced. 
The action of the heart becomes more rapid and its force lessened; the 
arterial tension falls, and the pulse assumes the dicrotic character. The 
functions of organs, especially of the brain and nervous system, lose 
energy. Nausea, vomiting, faintness, sj'ncope, and epileptoid seizures 
occur, when the loss of blood is considerable. Epileptiform convulsions 
is a constant phenomenon in animals bled to death (Kussmaul and 
Tenner). 

When the quantity of fluid in the vessels is lessened by bleeding, 
thirst is experienced, and absorption is more rapid ; the sensibility to 
pain is diminished, probably, because the perceptive centres are func- 
tionally inactive ; and the power to evolve force, muscular, digestive, 
nervous, etc., is greatly restricted. Only one function, therefore, is 
rendered more active by bleeding ; all the others are depressed in con- 
sequence of the inadequate supply of nutrient material. 

It is a remarkable fact, perfectly well known to old practitioners, 
and to which Sir James Paget has recently called attention, that the ill- 
effects of bleeding, in healthy subjects, are very temporary and easily 
repaired. The blood-globules, which are relatively more affected by 
bleeding than the other constituents, are quickly reproduced, and the 
functions of organs suddenly very much depressed soon recover their 
normal energy. That any permanent injury is done to the healthy 
human system by a moderate bleeding seems, therefore, to be highly 
improbable. 

Theeapt. — The limits of this work will not permit the introduction 
of any controversial discussions. The author is to be ranked with those 
who do not employ general bloodletting, but he does not deny that it 
is occasionally useful ; and that, indeed, it may be indispensable. A 
summary of the physical conditions in which venesection may be useful 
or indispensable should not, therefore, be omitted from a work on thera- 
peutics. 



BLOODLETTING. 619 

The therapeutical effect of a general bloodletting in congestion and 
inflammation is largely mechanical. In acute congestion of the lungs 
when aeration of the blood is seriously impeded ; when there are extensive 
stasis on the venous side, and ischsemia on the arterial side of the sys- 
temic circulation, great relief may be afforded by the abstraction of 
from four to sixteen ounces of blood. In the apoplectiform variety 
of acute cerebral congestion, damage to the brain may be prevented by 
letting blood. The effect of the bleeding is to diminish the intral-cranial 
pressure, and thus relieve the strain on the cerebral vessels. In eclamp- 
sia, especially of the puerperal variety, accompanied with the evidences 
of cerebral congestion, great relief may be procured by the timely ab- 
straction of blood. The quantity of blood to be taken will depend in 
part on the character of the subject and on the amount of congestion. 

The mechanical effect of the withdrawal of blood from the systemic 
circulation may be most advantageous in cases of sudden over-disten- 
tion of the right cavities of the heart. 

Pulmonary haemorrhage, when dependent on acute congestion of 
the lungs, the general condition being one of plethora, may be promptly 
arrested by opening a vein in the arm. 

The pain of acute pleuritis, and acute peritonitis, can be quickly 
relieved by bloodletting. 

Although it is undeniable that the important results above men- 
tioned may be obtained from general bleeding, it is equally certain that 
as good results in most of the conditions may be had by other methods. 
Acute diseases make such serious demands on the vital resources of pa- 
tients, that the practitioner should seriously ponder the propriety of 
taking blood even in those cases to the relief of which it may seem to 
be adapted. Large bleedings, experience has abundantby shown, render 
the convalescence from acute diseases tedious — for the patient has to 
make up the losses by venesection as well as the ravages of the disease. 

Bleeding by Cups and Leeches. — A large number of cups and 
leeches may produce the systemic effects of a general bleeding. But, 
as a rule, these applications are intended to withdraw blood from the 
affected part, and thus- act in the manner entitled revulsive. The local 
irritation caused by cups and leeches must, through the agency of the 
nervous system, affect distant parts in the same manner as other coun- 
ter-irritants. 

Leeches are preferable to cups when the parts are very sensitive, or 
inaccessible. The quantity of blood drawn can be more accurately 
measured when cups are used. The counter-irritant effects are much 
more pronounced from cups than from leeches. 

The amount of blood drawn by a leech will depend on its size, and 
the subsequent loss of blood, when the bleeding is encouraged, is deter- 
mined by the vascularity of the part. As a general rule it may be 
stated that a leech will draw about four times its own weight — about 
36 



G20 TOPICAL REMEDIES. 

one to two drachms. To obtain from any given patient four ounces of 
blood, one ounce of leecbes must be applied. 

In acute gastric, enteric, and peritoneal inflammations, if the patient 
be plethoric, and there is decided sthenic reaction, leeches to the abdo- 
men are very serviceable. The number to be applied will always 
depend on the effect to be produced, employing the rules given above 
as the basis of the estimate. In typhlitis and perityphlitis, the author 
has seen such good results produced by leeches, that he holds they 
should never be omitted when the tenderness and fever begin. In 
acute hepatitis and congestion of the liver, and in acute dysentery, the 
best results are obtained by the application of leeches to the margin of 
the anus. Hemorrhoids that are swollen, painful, and irreducible with- 
out great suffering, are much relieved by the application of leeches 
directly to them. Pruritus of the anus, when due to engorgement ol 
the portal circulation, and accompanied by heat of the anal region, may 
sometimes be cured by leeching the parts affected. 

Acute desquamative nephritis, pyelitis, and congestion of the hid- 
neys, are ameliorated by the application of cups to the lumbar region. 

The following acute affections of the respiratory organs, when they 
occur in robust persons, and are accompanied by sthenic reaction, are 
favorably influenced in their course and duration by the application of 
cups or leeches — usually the former: pleuritis, pericarditis, acute ton- 
sillitis, acute laryngitis, and inflammatory croup. 

In acute inflammations of the uterus and its appendages; decisively 
good results are obtained by the application of leeches to the hypo- 
gastric region, to the iliac fossa?, or to the uterus. 

Cupping the nape of the neck, or leeches to the mastoid process, are 
probably of service in acute congestion or inflammation of the intra- 
cranial structures ; but the indiscriminate empkrvment of bloodletting 
in any case of cerebral disease is to be condemned. The correct rule 
may be formulated as follows : When bloodletting is indicated in intra- 
cranial maladies, venesection or arteriotomy (temporal artery) is to be 
preferred to the use of cups or leeches. 

Although good results are obtained by the local abstraction of blood 
in the diseases above mentioned, the author must express his conviction 
that the chief utility of cupping and leeching consists not in the blood 
withdrawn, but in the derivant and counter-irritant effect which they 
produce. Dry cups, a mustard-plaster, a turpentine-stupe, or other 
counter-irritant application, may render the painful process of cupping 
or leeching unnecessary. 

ESCHAROTICS. 

The substances belonging to this group are employed for the pur- 
pose of destroying the tissues to which they are applied. They differ 
in their mode of action, in the extent of the destruction which thev 



ESCHAROTICS. ■ G21 

effect, in their capacity for diffusion into the blood, and in the results 
which they severally accomplish. 

They are prescribed for the purpose of cauterizing poisoned wounds 
— syphilitic ulcers, snake-bites, the bites of rabid animals — for the re- 
moval of gangrenous parts, foul or exuberant granulations, and espe- 
cially for the destruction of malignant growths. When the diseased 
parts, to the destruction of which they are devoted, have been fully 
acted upon, the caustic action is ended; poultices are applied to favor 
the entire separation of the sloughs, and a healthy surface is finally left 
to heal by granulations. 

The members of this group have, with one exception, been dis- 
cussed elsewhere: 

The mineral acids. 

The chloride and sulphate of zinc. 

Potassa fusa and potassa cum calce. 

Arsenious acid. 

The acid nitrate of mercury. 

Bromine. 

Acidum Chromicum. — Chromic acid. " In deep-red, needle-form 
crj'stals, deliquescent, and very soluble in water, forming an orange-red 
6olution." 

Actions astd Uses. — Chromic acid is an oxidizing caustic. When 
the action ceases, sesquioxide of chromium remains. It is slow in ac- 
tion, and not very painful, but it penetrates deeply and is remarkably 
destructive. Small animals, as mice and birds, are dissolved entirely, 
bones -and all, by chromic acid. Owing to the fact that it penetrates 
deeply without much pain y care must be used in its application as a 
caustic, lest it injure parts which are not intended to be affected. When 
it is applied as a caustic, the surrounding tissues must be well protected. 
For the destruction of malignant growths, haemorrhoids, ioarts, etc., the 
acid should be made into a paste by the addition of sufficient water. 
The part to which it is applied first becomes yellow, then brownish, and 
ultimately black, and the eschar is detached in from twenty-four to forty- 
eight hours. 

A solution of chromic acid of the strength of one hundred grains to 
an ounce of distilled water is an efficient local application in syphilitic 
warts and vegetations, condylomata, lupus, sycosis, tinea tonsurans, 
etc. A still stronger solution (grs. xv — 3 j of hot water) has been 
injected into the uterine cavity with success in cases of uterine haemor- 
rhage and uterine catarrh (Wooster). 

Authorities referred to : • 

Busch, Dr. E. Annuaire de Therapeutiquc, vol. xxiv., p. 229. 
Heller, Dr. Ibidem, 1853, p. 283. 
Marshall, John. The Lancet, 1857, vol. i., p. 88. 
Wooster, Dr. The American Journal of the Medical Sciences, 1869, p. 867. 



622 TOPICAL REMEDIES. 



EMOLLIENTS, DEMULCENTS, AND PROTECTIVE AGENTS. 

Glycerina. — Glycerine. " A colorless, inodorous, sirupy liquid, of a 
sweet taste, and having the specific gravity of 1.25. It is soluble in 
water and in alcohol, but not in ether." 

Glycerine- Ointment. — (Unofficial.) (Spermaceti, § ss ; white wax,' 
3 j ; oil of almonds, § ij ; glycerine, § j — add the glycerine to the 
melted ingredients, and stir briskly till cold) Squire. 

Glyconine. — An emulsion of glycerine and the yelk of eggs — four 
parts of the yelks and five parts of glycerine. 

Glycerine- Cream. — (Glycerine, 1 ; soft soap, 1 ; cherry-laurel wa- 
ter, 1) Squire. 

Glycerine- Cream with Camphor. — (Glycerine, 2 ; camphor, 1 ; rec- 
tified spirit, 1) Squire. 

Glycerita Amyli. — Glycerite of starch. (Starch, 1 ; glycerine, 8-J) 
Ph. Br. 

Properties. — Exposed to the air, glycerine slowly absorbs moist- 
ure, but it does not evaporate, and it does not become rancid or undergo 
fermentation spontaneously. It is unctuous to the touch, and is obsti- 
nately sticky. Glycerine possesses remarkable solvent powers. One 
part of iodine and one of iodide of potassium dissolve in two parts cf 
glycerine. Bromine, the iodide of sulphur, the chlorides of potassium 
and sodium, the alkalies, some of the alkaline earths, many of the neu- 
tral salts, the vegetable acids, especially tannic, most of the alkaloids 
(morphia, quinia, strychnia, veratria, and atropia), and carbolic acid, are 
soluble in glycerine. The fatty acids, cocoa-butter, camphor, chloroform, 
calomel, iodide of lead, and the resins, do not dissolve in glycerine. 

The antiseptic property of glycerine is decided. Vaccine lymph 
may be preserved unchanged almost indefinitely when stored up in pure 
glycerine ; and anatomical preparations, and specimens of natural his- 
tory, are kept in preservative solutions consisting chiefly of this sub- 
stance. Microscopical and pathological specimens are after a time soft- 
ened and disintegrated by pure glycerine. 

Applied to. the tissues of the body, glycerine, if pure, is perfectly 
bland and unirritating, as a rule, but in some subjects severe smarting 
is produced on contact of the purest glycerine with the mucous mem- 
brane. When it contains the fatty acids, oxalic or formic acids, it pos- 
sesses very positive irritant qualities. It abstracts water from the tis- 
sues. 

Therapt.^No systemic effects are produced by the stomach ad- 
ministration of glycerine. It is an efficient remedy in acidity, pyrosis, 
audi flatulence, in the dose of a drachm, before, with, or after meals. 

Glycerine has been proposed and used as a substitute for cod-liver 
oil, in the various cachectic states in which the latter is prescribed. It 
has been conclusively shown that it is inferior to cod-liver oil in every 



GLYCERINE. 623 

respect. As a vehicle for the administration of cod-liver oil, it is 
extremely serviceable (glyconine, a teaspoonful ; cod-liver oil, a tea- 
spoonful ; tincture of cinnamon, ten drops). 

Good results have been reported from the use of glycerine in dia- 
betes, but the data are as yet insufficient to enable a correct estimate 
of its real value to be made. The internal administration of glycerine 
has been resorted to for the removal of acne with success. It is said 
to destroy intestinal trichina, and may be given freely in trichinosis. 

The most important applications of glycerine, besides its numerous 
uses as a vehicle, are topical as an emollient. Applied to the affected 
mucous membrane by means of a camel's-hair pencil, pure glycerine 
affords great relief in acute coryza. Chronic follicular pharyngitis, 
accompanied with profuse secretion, is generally improved by the same 
application, but the addition of tannic acid greatly enhances its cura- 
tive power in this affection. A solution of morphia in glycerine, ap- 
plied to the fauces with a brush, relieves the cough of p>hthisis. A bet- 
ter application in many respects is a mixture of glycerine, crystallized 
sugar, and whiskey. This mixture, allowed to trickle slowly down the 
fauces, allays irritability and keeps the mucous membrane moist (gly- 
cerine, two parts ; whiskey, one part ; crystallized sugar, a sufficiency). 

An enema of glycerine and' infusion of flaxseed (one to four) allays 
the tenesmus in cases of acute dysentery. 

For chapped hands or face, glyconine is an excellent application. 
In seborrhoea, glycerine-cream gives good results. For fissures of the 
nipple, Stille strongly recommends a " liniment made by adding one 
part of tincture of benzoin to six or eight of glycerine, and filtering the 
mixture." 

' In pityriasis and in the papular eruptions, glycerine is serviceable, 
but, in general, it may be stated that its use in skin-diseases is disap- 
pointing, and that it is inferior as a local application to the usual oils 
and fats employed in this way. 

Glycerine has been used as a dressing for wounds and tdcerated 
surfaces, with more or less advantage. It is largely prescribed by gynre 
cologists as a topical application to erosions and ulcerations of the cer- 
vix uteri, and for the relief of vaginal leucorrhcea. 

The glycerite of starch (plasma) is an excellent vehicle for the appli- 
cation of astringents to the eye, and is much employed by ophthal- 
mologists for this purpose. Glycerine is used by otologists to soften 
cerumen, to entangle insects which have entered the ear, to diminish 
the secretion of pus, and to relieve the morbid state of the auditory 
canal in cases of otorrhcea. 

Collodium. — Collodion. " Is a slightly opalescent liquid, of a sirupy 
consistence. By long standing it deposits a layer of fibrous matter, and 
becomes more transparent. This layer should be reincorporated, by 



624 TOPICAL REMEDIES. 

agitation, before the collodion is used. When applied it should form a 
colorless, transparent, flexible, and strongly contractile film." 

Collodium Flexile. — Flexible collodion. (Collodion, Canada tur« 
pentine, castor-oil.) 

Liquor Gutta-Perchze. — Solution of gutta-percha. (Gutta-percha, 
carbonate of lead, purified chloroform.) 

Actions ajstd Uses. — These solutions, when applied to the integu- 
ment, evaporate, leaving a transparent film or coating impervious to 
air and moisture. In drying collodion contracts energetically, and may 
indeed produce such a degree of constriction as to cause pain, and to 
render the part bloodless. Flexible collodion contains turpentine and 
castor-oil, which confer the property of flexibility, while they do not 
impair the impermeability of the film. .The solution of gutta-percha 
has properties similar to flexible collodion. 

These solutions are employed to protect exposed parts from the 
contact of air, to secure primary union of incised wounds, to cause reso- 
lution of inflamed parts by mechanical pressure, etc. 

Some cases of chronic tubercular and squamous sJcin-diseases are 
much improved by coating them with the gutta-percha solution. Pre- 
vious to the application of the solution all scales should be removed. 
Excellent results have been obtained in herpes zoster by a thick coating 
of the flexible collodion, or the gutta-percha solution : the pain is re- 
lieved, the vesicles aborted, and the duration of the disease shortened. 
As this is a self-limited disease, there must remain a suspicion of post 
hoc rather than propter hoc. Erysipelas, especially of the traumatic 
variety, is, at least, much relieved as regards the local symptoms by a 
thjck coating of flexible collodion, but there is no evidence that it actu- 
ally shortens the duration of the disease. Bums to the first degree 
are greatly benefited by the same application ; it prevents contact of 
the air, and allays the irritation and pain. When, however, there is 
much exudation, or sloughing takes place, an impermeable coating adds 
to the distress. 

Collodion has been used without much success in small-pox, to hin- 
der the development of the pustules. Small boils, carbuncles, ncevi, 
and even superficially placed aneurisms, may be so compressed as to 
arrest the local inflammation or to cause coagulation of the blood. 
Orchitis may be treated by a coating of collodion, instead of strapping. 
When the mechanical effects of the collodion are to be obtained, succes- 
sive layers must be applied. 

Fissures of the nipples are best treated by flexible collodion or gutta- 
percha solution. The fissures are carefully wiped dry, well approxi- 
mated, and then thoroughly coated. Nipples that are retracted may 
be made more prominent by surrounding them, after being well drawn 
out, with a thick layer of collodion so placed that on contracting it will 
pucker the skin of the areola. 



CETRARIA. . 0;>.-j 

Collodion has been used with success as a means of compression in 
umbilical hernia, spina-bijida, varicocele, etc. 

Chondrus. — Ghondrus Grispus. Irish moss. 

Cetraria. — Cetraria Islandica. Iceland moss. 

Decoctum Cetraria}. — Decoction of Iceland moss. 

Composition. — The principal constituent of chondrus is a mucilage, 
which, when dry, is horny, but swells up in water forming a jelly. 
Cetraria contains about seventy per cent, of a starch (lichen-starch), a 
decoction of which gelatinizes on cooling. In addition to this starch 
cetraria contains a bitter principle (cetrarin), and a peculiar acid (lich- 
eno-stearic acid). 

These lichens are used only for the production of diets for the sick. 
They were formerly supposed to possess some peculiar virtues which 
rendered them serviceable to pulmonary invalids. As articles of food, 
they have a very low position as regards nutritive value. The decoc- 
tion of cetraria may be used as a stomachic tonic, containing as it does 
a bitter principle ; but it is only to be prescribed when the more effi- 
cient remedies are not well borne. 

Chondrus may be made into jelly or blanc mange, in the same way 
as gelatine is now prepared for this purpose. Neligan gives the fol- 
lowing recipe for the preparation of a jelly from chondrus: Chondrus, 
washed and macerated, thirty grains ; spring-water, a pint ; boil down 
to one-half and strain with expression, and add to the strained liquor 
four ounces of white sugar, one ounce of gum-acacia, and thirty grains 
of powdered orris-root ; heat to dryness with a gentle temperature, 
stirring constantly so as to obtain a pulverulent mass, to which three 
ounces of arrow-root are to be added by trituration. A jelly is pre- 
pared with this powder by rubbing a teaspoonful of it with a little cold 
water, and then pouring a cupful of boiling water on it. 

Acacia. — Gum-arabic. " A gummy exudation from acacia vera, and 
other species of acacia." 

Mucilago Acacias. — Mucilage of gum-arabic. 
Syrupus Acacias. — Sirup of gum-arabic. 

Tragacantha. — Tragacanth. " The gummy exudation from astraga- 
lus verus, and from other species of astragalus." 

Mucilago Tragacanthaz. — Mucilage of tragacanth. 

Sassafras Medulla. — " The pith of the stems of sassafras officinale.' 
Mucilago Sassafras 3Iedullm. — Mucilage of sassafras-pith. 
Actions and Uses. — These preparations are used as demulcent 

drinks, in cases of acute inflammation of the stomach and intestines. 

They are supposed to make a protective coating on the inflamed part, 
• 41 



626 TOPICAL REMEDIES. 

and thus save it from further injury. They are especially indicated 
when irritating and corrosive substances have been swallowed. They 
are also frequently prescribed as diet-drinks in fevers and in acute in- 
flammations, in accordance with the supposition that they are not only 
soothing to the alimentary canal but are, in a limited sense, foods. A 
nutrients these gums and mucilaginous substances rank very low, and 
can by no means take the place of such a food as milk. Furthermore 
they are exceedingly apt to undergo fermentation, and to produce flatu- 
lent colic and diarrhoea. 

Mucilaginous drinks are very frequently taken in catarrhal affections 
of the bronchial tubes and of the kidneys, with the view to modify the 
morbid process going on in these parts. It need hardly be stated that 
such a theory of the utility of demulcents is erroneous. Cough is modi- 
fied by an influence which is probably reflex, when mucilages are ap- 
plied to the fauces; but in no other way can the mucous membrane of 
the air-passages be affected by such remedies taken into the stomach. 
As gums undergo digestion in the alimentary canal, it is obvious that 
they cannot act as demulcents on any part of the urinary tract. 

The chief use of these remedies is in extemporaneous prescriptions, 
to hold insoluble medicines in suspension, and to cover the taste of 
disagreeable ingredients. 

Linum. — Flaxseed. " The seed of linum usitatissimum." 
Lini Farina. — Flaxseed-meal. 

Infusum Lini Composition. — Compound infusion of flaxseed. 
(Flaxseed, § ss ; liquorice-root, 3 ij ; boiling water, Oj.) 

UlmilS. — Slippery-elm bark. " The inner bark of ulmus fulva." 
Mucilago Ulmi. — Mucilage of slippery-elm bark. 

Glycyrrlliza. — Liquorice-root. " The root of glycyrrhiza glabra. 

JSxtractum Glycyrrhizce. — Extract of glycyrrhiza (liquorice). 

Mistura Glycyrrhizce Composita. — Compound liquorice -mixture 
(brown mixture). A simple expectorant containing paregoric, wine of 
antimony, and spirits of nitrous ether. Dose, 3 j — 1 ss. 

Actions and Uses. — The remedies of this group contain mucilagi- 
nous constituents on which their properties depend. They are fre 
quently prescribed as protectives in gastro-intestinal disorders, and as 
expectorants in bronchial affections. 

Poultices. — Flaxseed-meal, powdered slippery-elm bark, and Indian 
or corn meal, are most frequently used for the preparation of poultices. 
Wheat-bread and milk are also occasionally employed for the same 
purpose. 

In the preparation of a poultice, the meal is slowly incorporated 






POULTICES. G27 

with hot water, until a mass of the proper consistency is made. The 
mixture itself should not be applied immediately to the part, for it dries 
and adheres with considerable tenacity. A piece of washed muslin of 
quadrangular shape, and of sufficient size, is selected ; the hot mass is 
spread on one end of the muslin, leaving a margin of one inch on three 
sides ; the long end of the muslin is then folded over the mass, and the 
free margins are stitched or pinned together. If the poultice is not 
frequently renewed, to prevent drying, some glycerine should be added 
to the surface which is to remain in contact with the tissues. Lauda- 
num, or other narcotics, may be stirred in with the meal if the relief of 
pain be desirable. 

A yeast-poultice consists of brewers' yeast, to which sufficient flax- 
seed is added to give the proper consistence. 

A charcoal-poultice differs from an ordinary poultice in having pow- 
dered charcoal incorporated with the mass. In order that a charcoal- 
poultice shall have the proper consistence, the mass should be thin 
enough to take up a sufficient quantity of charcoal. 

Actions and Uses. — A poultice is a means of applying continuous 
heat with moisture, and of softening the tissues. An afflux of blood 
takes place to the part, the vessels dilate, the tissues, softened by the 
combined influence of heat and moisture, permit the easy diffusion of 
the fluids. If the process of inflammation has .begun, or is in progress, 
the stasis is relieved, the tension of the inflamed part is lessened, and 
resolution is thus favored ; or, if the stage of exudation is reached, the 
migration and multiplication of the white corpuscles are promoted, and 
the extrusion of purulent elements facilitated. The accumulation of 
blood in the neighborhood of the poultice seems to diminish the press- 
ure elsewhere, and thus poultices of large size lower the arterial tension 
and lessen stasis in internal parts. Poultices relieve the pain of in- 
flamed parts by relaxing the tissues, "and thus removing pressure from 
the sensory nerve-filaments. The impression thus made on the periph- 
eral nerve-endings is transmitted to the centre and reflected over in- 
ternal organs. It is within the range of everybody's personal experi- 
ence that warm, moist applications relieve pain in internal and distant 
parts, which have no anatomical connection with the integument to 
which the applications are made. 

Poultices have, therefore, a local and a systemic effect. Their thera- 
peutical uses are based on this conception of their physiological actions. 
They are prescribed to relieve the tension and to promote resolution 
or suppuration in boils, carbuncles, and other superficial inflammations, 
to hasten the healing of irritable ulcers, to favor the separation of 
gangrenous sloughs, etc. Foul-smelling wounds requiring the use of 
poultices are best treated with the yeast or charcoal poultice. 

Unquestionable benefit is derived from the application of hot poul- 



628 TOPICAL REMEDIES. 

tices externally in acute faucial inflammations , in pneumonia, pleurU 
tis, pericarditis, hepatitis, peritonitis, etc. 

The application of poultices sometimes degenerates into abuse. If 
too long continued, the skin becomes white, wrinkled, and sodden ; 
small abscesses or boils form, and the vessels of the parts very slowly 
regain their tone. If kept too long in contact with wounds or ulcer- 
ated surfaces, the granulations become pale and flabby, and the healing 
process is retarded. Applied indiscreetly to inflamed joints, they may 
promote suppuration, and thus permanently injure these structures. If 
kept long in contact with a large extent of surface, they will lower the 
general tone and vigor of the system, depress the systemic circulation, 
exhaust the irritability of the vaso-motor nerves, and thus seriously 
embarrass the reparative process, if not wholly prevent repair. 






IKDEX OF EEMEDIES. 



A 

Acacia 625 

Aceta : 

Acetum Opii 422 

Scilte .602 

Acida : 

Acidum Arseniosum 185 

Aceticum 207 

Benzoicum 544 

Boracicum 542 

Carbolicum 517 

Chromicum 621 

CUricum 2Q7 

Gallicum 278 

Hydrocyanicuiii Dilutum 4S4 

Lactlcum 85 

Muriaticuin 8S 

Nitricum 88 

Nitromuriaticum 88 

Phosphoricum 88 

■ ■ Salicylicum 529 

Sulphuricum 87 

Sulphurosuin 209 

Tannicum 273 

Tartaricum 207 

Aconitia 495 

Aconitum Napellus and its preparations 494 

Acupuncture 61 6 

Adeps 95 

./Ether 898 

Ailanthus 50S 

Air '. 71 

Compressed 73 

Alcohol 883 

Ale 396 

Aliment 19 

A I imontation, Eectal 51 

Alkalies 178 

Alkaline Mineral Springs 198 

Alnus Cerulata 275 

Aloes and its preparations 569 

Aloin 570 

Alum 269 

Alumen . .-. 269 

Exsiccatum 269 

&mmonia 209 

Ammoniacum and its preparations 872 

Ammonia! Valerianns 372 



PAGE 

Ammonium and its preparations 199 

Ammonii Benzoas 544 

Amygdalae Oleum Expressum 95 

Amyl Nitrite 489 

Anaesthesia 404 

Local 412 

Anaesthetics 404 

Animal Diet 21 

Anemonin 504 

Anthelmintics 582 

Antimony and its preparations 2C3 

Antiseptics 513 

Antiseptic Oils 540 

Apiol 604 

Apomorphia 551 

Aqua : 54 

Aqu^e: 

Aqua Aeidi Carbolica 517 

Ammoniae 200 

Chlorinii 515 

Creosoti 617 

Aquapuncture 616 

Argentum and its preparations 241 

Aricina 466 

Arnica and its preparations 406 

Aromatic Bitters 151 

Arsenic and its preparations 135 

Arterial Transfusion 16 

A6afcetida and its preparations 869 

Atomization of Liquids 6 

Atropia 348 

Aurum and its preparations 239 

B 

Bantingism 35 

Barium 205 

Barii Chloridum 205 

Baths 57 

Baunscbeidtismus 616 

Beer 390 

Belladonna and its preparations 345 

Benzoates 544 

Benzoic Acid 544 

Benzoin 544 

Berberina 155 

Berberis 136 

Beverages ' 51 

Bismuth and its preparations 133 

Bitters, Aromatic 151 



630 



INDEX OF REMEDIES. 



PAGE 

Bitters, Simple 143 

Blisters 612 

Bloodletting 618 

Brandy 333 

Brayera and its preparations 5S7 

Bromine 516 

Bromides : 

Ammonium 443 

Calcium 443 

Lithium 443 

. Potassium 443 

Sodium 443 

Broom 601 

Broths, Animal, Formula; for 45 

Brown Mixture 626 

Brucia 310 

Buchu and its preparations 600 

Burgundy Pitch 611 

Buttermilk-Cure 42 

C 

Cacao Butter .' 96 

Cadmium and its preparations 268 

Caffein and its preparations 3S0 

Calabar Bean 472 

Calcium 1S8 

Calomel 228 

Calumba and its preparations 148 

Calx 1S8 

Chlorinata 515 

Calcii Phosphas Praecip Ill 

Camphor and its^ preparations 366 

Camphor Monobromate 366 

Cannabis Americana 376 

Indica 376 

Canquoin's Paste 262 

Cantharidal Collodion 612 

Cantharidine 608 

Cantharis and its preparations 608 

Capsicum and its preparations 597 

Carbolic Acid 517 

Carlsbad 197 

Carota 601 

Caryophyllus 546 

Cascarilla 152 

Castanea Vesca 275 

Castor-oil 561 

Catecbu and its preparations 273 

Cathartics 558 

Centaury Americana 149 

Cekata : 

Ceratum Cantharidis 612 

-Extracti Cantharidis 612 

Plumbi Subacetatis 253 

Zinci Carbonatis 259 

Cerebral Excitants 866 

Cerium and its preparations 269 

Cetraria 625 

Cetrarin 625 

Chalk 1 S3 

Chalybeate Mineral Springs 130 

Champagne , 392 

Chaet.£ : 

Charta Cantharidis 612 

Sinapis 610 



PAGE 

Chelidonie Acid 289 

Chenopodium and its preparations 5S5 

Chimaphila and its preparations 601 

Chinoidine 159 

Chloral Hydrate 414 

Croton 420 

Chlorinated Lime 515 ' 

Chlorine 51 5 

Chlorodyne 403 

Chloroform 400 

Chondrus 625 

Chromic Acid 621 

C'hry sophanic Acid 568 

Cimicifuga and its preparations 845 

Cimicifugine 346 

Cinchona and its preparations 158 

Cinchonia 159 

Citric Acid 20T 

Citrine Ointment 229 

Coca 879 

Cocoa 52 

Codia 423 

Cod-liver Oil 96 

Coffee 51 

Colchicia 281 

Colchicum and its preparations 281 

Collodion 623 

Collodium cum Cantharide 612 

Collodium Flexile 624 

Colocynth and its preparations 573 

Confection es : 

Confectio Bosse 274 

Opii 421 

Sennae 566 

Conia 453 

Conium and its preparations 453 

Copaiba and its preparations 593 

Copper, preparations of 249 

Coptis 149 

Cornus Florida 143 

Corrosive Sublimate 223 

Counter-irritants 610 

Creosote 5:7 

Creta 188 

Croton-Chloral ". 420 

Croton-oil 1 577 

' Cubeb and its preparations 596 

Cuca 379 

Cupri Sulphas £49 

Cuprum and its preparations 249 

Curara 457 

Curarine 458 

Cyanide of Potassium 4S7 

D 

Dandelion 602 

Daturia..'. 359 

Deoocta : 

Decoctum Cetrariffi 625 

Chimiphila? 601 

Cinchonas Flavae 153 

« Rubra: 153 

Cornfts Florida; 149 

Hnematoxyli 274 

QuercusAlbae 274 



INDEX OF REMEDIES. 



G31 



PAGE 

Dccoctum Sarsaparillre Compositum 284 

Uviv I'rsi 600 

Domulcents 622 

Dcnutrltlon 84 

Diet-Drinks, formula.' for 45 

ion-Ferments 81 

I Ugitalln 888 

Digitalis aud Its preparations 88S 

Doucbe 5s 

Nasal 5 

Dover's Powders 421 

Dry Diet 86 

Duboisia 864 

E 

Effervescing Powders /. 186 

Elaterln 5T9 

Elaterlum 579 

Electricity 298 

Electrolysis 296, 307 

Emetia 558 

Emetics 549 

Emollients 622 

Emplastra * 

Emplastrum Ammoniac! 872 

Ammoniaci cum Hydrargy ro 227 

Antimonii 264 

Arnica? fill 

Aeafcetida; 869 

Belladonna? 848 

Ferri 115 

Hydrargyri 227 

f Opii 421 

Picis Burgundies; 611 

Picis Canadensis 611 

Picis cum Cantharide 611 

Tlumbi 253 

Ems 194 

Endermic Method 4 

Enemata 580 

Forms of 581 

— — Nutrient , 50 

Enepidormic Method 3 

Epidermic Method 4 

Epispastics 612 

Epsom Salts 562 

Ergot and its preparations 825 

Ergotine 325 

Erlgeron •. .-... 600 

Escharotics 620 

Esi'rine 472 

Ether 898 

Eucalyptol 158 

Eucalyptus and its preparations 158 

Euonymus 576 

Euonynim 576 

Evacuants 549 

Extracta : 

Extractuin Aeoniti 494 

Belladonna; 84S 

Belladonnas Alcoholicura 848 

Cananbis Americans? 876 

" Indica 876 

Cinchona 15S 

Colchici Aceticum 281 



PAOE 

Extractum Colocynthldis 573 

Colocynthldis Compositum 573 

Conii 453 

" Alcoholicum 458 

Digitalis 83s 

Eucalypti *. 168 

Gentianm 14s 

GlycyrrhizjB 626 

Htematoxyli 271 

Hyoscyami 860 

" Alcoholicum 860 

Jalapa; 572 

Kramerioe 273 

Nucis Vomica; 810 

Opii 421 

Physostigmoe 472 

Podophylli 574 

Quassia; 143 

Khei 567 

Stramonil 859 

Taraxaci 602 

EXTEACTA FLCTDA ! 

Extractum Ailanthi Fluidum 503 

Belladonna; Kadicis Fluidum 848 

Buchu Fluidum 600 

Calumba; Fluidum 149 

Chimiphila; Fluidum 602 

Cimicifuga Fluidum 345 

Cinchona; Fluidum 158 

Coca? Fluidum 879 

Colchici Eadicis Fluidum 2sl 

" Seminis Fluidum 2-1 

Conii Fructus Fluidum 453 

Cornus Florida; Fluidum 149 

Cubeba; Fluidum 596 

Digitalis Fluidum 838 

Ergota; Fluidum 825 

Gelsemii Fluidum 462 

Gentians Fluidum 14S 

Grindelia; Fluidum 505 

Hydrastis Fluidum 155 

Hyoscyami'Fluidum 360 

Ipecacuanha; Fluidum 553 

Jaborandi Fluidum 469 

Eramerite Fluidum 273 

Lupulinae Fluidum 441 

Pareiraa Fluidum 600 

Phytolacca; Fluidum 506 

Pilocarpi Fluidum 469 

Pruni Virginians? Fluidum ! 158 

Khei Fluidum 567 

Sabina; Fluidum 607 

SarsaparilUe Fluidum 2S4 

" Compositum Fluidum 284 

Senna; Fluidum 566 

■ Serpentaria; Fluidum 152, 874 

Spigelian Fluidum 5S5 

Spigelhe ct Senna; Fluidum 565 

Stillingia; Fluidum 257 

Taraxaci Fluidum 602 

TJva TJrsi Fluidum 600 

Ustilaginis Maidis Fluidum 827 

Valeriana? Fluidum 872 

Veratri Viridis Fluidum 499 



632 



INDEX OF REMEDIES. 



PAGE 
F 

Faradism : 295 

Fats and Oils 95 

Ferments 81 

Ferrum and its preparations 115 

FilixMas 586 

Firing 616 

Flax-seed 626 

Flexible Collodion 624 

Fluid Extracts (see " JExtracta Fluida "). 

Fowler's Solution 135 

Friedrichshall 198 

Fumigations 7 

G 

Galla -. 272 

Gallic Acid 273 

Galls 273 

Galvanism 294 

Galvano-caustic 308 

Gamboge 576 

Gargles 279 

Gaultheria 547 

Gelsemia 463 

Gelsemium 462 

Gentian 148 

Catesby's 148 

Geranium 274 

Glycerine 622 

Gltcbeita : 

Glyceritum Acidi Carbolici 517 

Acidi Gallici 273 

" Tannici 272 

Glycyrrhiza 626 

Gold and its preparations 239 

Goldthread 149 

Goulard's Extract 253 

Ointment 253 

Granati Fructus Cortex 5S6 

Grape-Cure 37 

Grindelia 505 

Guarana '. 3S2 

Guaiacum 285 

H 

Hamamelis Virginica 275 

Haematoxylon and its preparations . .- 274 

Heat 67 

Hemlock 453 

Heuehera 275 

Hip Bath 59 

Homburg 19S 

Hope's Mixture 91 

Hops 441 

Humulus and its preparations 441 

Hydragogue Cathartics 576 

Hydrargyrum and its preparations 227 

Hydrastia 155" 

Hydrastis and its preparations 155 

Hydrate of Chloral 414 

Hydrocyanic Acid 484 

Hydroquinone 542 

Hydrotherapy 55 

Hyoscyamia 860 

Hyoscyamus and its preparations 360 

Hypodermatic Method 10 



PAGE 

I 

Ice-Bag 61 

Infusa : 

Infusum Buchu 600 

Calumbae 149 

Capsici 597 

Cascarillse 152 

Catechu Compositum 273 

Cinchona; Flavae 158 

" Rubra; 158 

Coca; 379 

Digitalis 888 

Gentiana; Compositum 143 

Humuli 441 

Jaborandi 469 

Juniper 599 

Kranieriae •. 274 

Lini Compositum 626 

Pareirae. . 600 

Pilocarpi 469 

Pruni Virginianae 152 

Quassia? 148 

Ehei 567 

Bosae Compositum 274 

Sennae 566 

Serpentaria? 374, 151 

Spigeliae 5S5 

Tabaci 477 

Taraxaci 602 

Valerianae 372 

Igasuric Acid 310 

Ingluvin 81 

Inhalations 6 

Injections— Intravenous 12 

Insufflation , 4 

Inunction Method 99, 236 

Iodides 216 

Iodine and its preparations 216 

Iodoform 216 

Ipecacuanha and its preparations 553 

Iris Versicolor 5J6 

Iridine 576 

Iron and its preparations 115 

J 

Jaborandi and its preparations 469 

Jalap and its preparations 572 

Jervia 5OT 

Juniper and its preparations 599 

K 

Kameela 537 

Kino and its preparations 273 

Kissingen 198 

Koumiss 41 

Kousso 5^7 

Koussine 5S7 

Krameria and its preparations 273 

L 

Lactic Acid £5 

Lactucarium 442 

Lactucarine 442 

Lard 95 

Laxatives 559 

Lead and its preparations 253 






INDEX OF REMEDIES. 



633 



PAOI 

Leptandra 575 

Leptandrino 575 

Lime and its preparations. 1S8 

Llni Farina 626 

Linuiii and its preparations (WO 

LlNIMKNTA : 

Lluimontum Aconitl 495 

Ammonia) 611, 200 

Camphora? 611, S6G 

Cantharidis 619 

Chloroformi 402 

Saponis 866 

TcrebinOiina: 583,611 

Liquores : 

Liquor Ammonia? Aeetatis 200 

Arsenici Chloridi 185 

Arsenici et Hydrargyri Iodide 135 

Ferri Citratis 116 

Caleis 1SS 

Caleis Saccharatus 1SS 

Ferri Chloridi 116 

" Nitratis 116 

" Subsulphatis 115 

" Tersulpuatis 115 

Gutta-Percba; 624 

Hydrargyri Nitratis 229 

Iodinii Compositus 21 6 

■ Magnesii Citratis 562 

Morphia; Sulphatis 423 

" Bimeconatis 423 

Pancreaticus 82 

Plumbi Subacctatis 253 

Potassaj ITS 

Potassii Arsenitis 155 

■ " Citratis ITS 

Soda: 1S5 

Sodas Cblorinataj 515 

Sodii Arseniatis 135 

Zinci Chloridi 259 

Liquorice 626 

Lithium and its preparations 189 

Lobelia and its preparations 4S1 

Lobelina 482 

Lupulin 441 

M 

Malt Liquors 896 

Magnesia and its preparations 560 

Magnesll Carbonas .• 560 

Citras 5G2 

Sulphas 562 

Manganesium and its preparations 127 

Manna 559 

Massage 78 

Mel Rosas 2T4 

Mercury and its preparations 22T 

Mercurial Inunction 236 

Fumigation 236 

Purgatives 565 

Milk as a Beverage ■ 53 

Milk-Diet 9 

MlSTTTEiE : 

Mistura Ammoniaci 372 

Asafoetida; 869 

Crcta:. 188 



PAGE 

Mistura Ferri Aromatlci 117 

Ferri Composita lift 

" Laxans 117 

Gentiance Alkalina 14S 

" ct Senna; 148 

Glycyrrhizaj Composite 626 

Mongers Solution 115 

Morphia and its Salts 423 

Mucilagines: 

Mucilago Acaciie 625 

Sassafras Medulla? 625 

Tragacanthaj 625 

Ulmi 626 

Mucuna 5S8 

Muriatic Acid 88 

Muscaria 503 

Mustard 610 

Myrica Cerifica 274 

Myrtol . . 543 

N 

Narceine 430 

Narcotinc 429 

Nasal Douche 5 

Nicotia 4TS 

Nicotianine 47S 

Nitre 173 

Nitric Acid S3 

Nitrite of Amy] 4S9 

Nitro-glycerine 491 

Nitro-Muriatic Acid SS 

Nitrous Oxide 413 

Nutrient Enemata 50 

Nux Vomica and its preparations 810 

Nympha; Odorata 275 

O 

Oils and Fats 95 

Olea Destiixata : 

Oleum Cajuputi 547 

Caryophylli 546 

Chenapodii 5S5 

Copaiba; 594 

-Cubeba; 596 

Erigorontis Canadensis 600 

■ Gaultheria) 547 

Juniperi 599 

Kicini 561 

Euta; COG 

Sabina? 667 

Tabaci 4TS 

Terebinthinae B88 

Thymi : 547 

Oleate of Mercury 229 

Oleoeesin^e : 

Oleoresina Capsici 597 

Cubeba; 596 

Filicis 5^6 

Lupulina;.. 441 

Piperis 597 

Oleum Amygdala; Ex[>ressum 95 

Lini 93 

Morrhua? 96 

Oliva? 96 

Phospboratum 102 

Eiciui 561 



634 



INDEX OF REMEDIES. 



PAGE 

Oleum Theobromoe 06 

Thyrni 847 

Tiglii 577 

Valerianic 873 

Opium and its preparations 421 

Oxygen 518 

P 

Pancreatine 82 

Paverine 422 

Paregoric 421 

Pareira 600 

Parilline 284 

Parish's Chemical Food Ill 

Parsley 604 

Pelleterine 586 

Pepo 587 

Pepsin 81 

Peptones . . . 88 

Petroselinum 604 

Phosphates and Phosphites Ill 

Phosphoric Acid 8S 

Phosphorus and its preparations 102 

Physostigma and its preparations 472 

Phytolacca 506 

Picrotoxine 322 

Pilocarpine Nitrate 469 

Pilocarpus 469 

Pilule : 
Pilute Aloes 569 

" et Asafotidiie 569,369 

" et Mastiches 569 

" etMyrrhae 569 

Antimonii Composite 228 

Asafcetidse ,. 369 

— — Carthartica? Composite 573 

Copaibae 594 

Ferri Carbonatis 115 

" Composite 115 

" Iodidi 116 

Galbani Compositai 870 

Hydrargyri 227 

Opii 421 

Phosphori 102 

Quinise Sulphatis 159 

Bhei 567 

" Compositoe , 568 

Scillae Composite 602, 372 

Saponis Composita? 421 

Pink-root 5S5 

Piper 597 

Piperinc 597 

Pipsissewa and its preparations 601 

Plumbism 254 

Plumbum and its preparations 253 

Podophyllum 574 

Polygonum Hydropiperoides 605 

Pomegranate 5S6 

Porphyroxine 2S9 

Porter 896 

Potassii Cyanidum 487 

Permanganas 127 

et Sodii Tartras 565 

Potassium and its preparations 178 

Poultices 626 



PAGE 

Propylamine 467 

Prunus Virginiana 152 

Prussic Acid 4S4 

Pulsatilla 504 

Pulvebes : 

Pulveres Effervescentes 186 

Effervescentes Aperientes 565, 186 

Pulvis Aloes et Canellae 570 

Ipecacuanha; Compositus 553, 421 

Jalapae Compositus 572 

Glycyrrhizae Compositus 560 

Pulverization . 6 

Pumpkin-seed 587 

Purgatives 558 

Pyrocatechin 542 

Q 

Quassia and its preparations 148 

Quercus and its preparations 274 

Quinia and its Salts 159 

— — for Hypodermatic Use 174 

E 

Easpail's Eau Sedatif 200 

Eeichenhall 199 

Eesin.e : 

Besina Jalapae 572 

■ Podophylli 574 

Guaiaci 285 

Scammonii 573 

Eesorcin 540 

Ehatany and its preparations ' 278 

Eheum and its preparations 567 

Khubarb 567 

Eosa Gallica and its preparations 274 

Eottlera 537 

Eubei'acients 610 

Eubus 274 

Eue 606 

Eussian Baths 57 

S 

Sabadilla 500 

Sabbatia 149 

Sabina 606 

Sal Ammoniac 200 

Salicin v 52S 

Salicylate of Soda ." 529 

Salicylic Acid 529 

Sanguinaria and its preparations 2S9 

Sanguinarine 2S9 

Sanguinarinic Acid 2S9 

Saline Mineral Waters 193 

Saline Purgatives 562 

Santonica 533 

Santonin 583 

Saratoga Springs 196 

Sarsaparilla 284 

Sassafras Medulla. 625 

Savine 606 

Scammony and its preparations 573 

Scilla and its preparations 602 

Scoparius 601 

Seidlitz Powders 1S6, 565 

Senna and its preparations 566 

Serpentaria and its preparations 874, 151 



INDEX OF REMEDIES. 



C35 



PAGE 

Sevum IB 

Silver and iis pranarat! ms 241 

Blnspta Alba 610 

Nigra 610 

6ltz Bath 59 

Bmllaclna 2^4 

Bodll Phoaphas 565, ill 

Pyrophoapbaa Ill 

Ballcylaa B20 

Sulphas 565 

Sodium and its preparations 185 

Bpigella and Its preparations 565 

Spiritcs : 

Spiritus ,'Ktlieris Cmnposltus 898 

,-Etheris Nitrosi 898 

Ammonia? 200 

Aminoniio Aroraaticus 200 

Frumonti 888 

' Vini Gallici 888 

Camphorte 866 

Chloroformi 401 

Juniper Compositus 599 

Squill 602 

Statice Limonium 2T5 

Steam bath 57 

Stillingia and its preparations 286 

Stillingin 2S7 

Stramonium and its preparations 859 

Strychnia and its Salts 811 

Styptic Colloid 278 

Succus Conii 453 

Sulphides 210 

Sulpho-Carbolates 527 

Sulphur and its preparations 559 

Sulphuric Acid 87 

Sulphurous Acid 209 

Sulphurous Mineral Waters 213 

SvppostTORiA : 

Suppositoria Acidi Tannici 273 

AloC-s 582 

Belladonna? 84S 

Sykupi : 

Syrupus Acacia; 625 

Calcii, Sodii, et Ferri Hypophosphitis .. Ill 

" Lacto-phosphatis Ill 

Ferri Iodidi 116 

" et Manganesii Iodidi 127 

" " Phosphatis 117 

Ipecacuanhas •. 553 

Krameria; 274 

Lactucaril 442 

Manganesii Iodidum 127 

Pruni Yirginianse 152 

Ehei 568 

" Aromaticus 568 

Bubi 274 

Sarsaparilla? Compositus 284 

Scilla? 602 

" Compositus 602, 264 

T 

Tabacnm and its preparations 477 

Tannic Acid 272 

Taraxacum 602 

Tartar Emetic 263 



PAOB 

Tartaric Acid 207 

Toa 62 

Terebinthina 588 

Thcbaia 422 

Thymol 547 

TiMTiu.t: 

Tinctura Aconitl Iladicis 495 

Aloes 569 

■ " et Myrrha; 509 

Arnica; 4G6 

Asafretida? 869 

Belladonna? 848 

Benzoini 544 

" Composita 544 

Calumba? 149 

Cannabis Indies; 876 

Cantharidis 608 

Capsici 597 

Catechu ; 273 

Cimieifuga: • ! 845 

Cinchonas 158 

" Composita 153 

Colehici 281 

Cubeba: 596 

Digitalis 33S 

Eucalypti 153 

Ferri Acctatis jEtheria 117 

" Chloridi 11G 

Galla? 273 

Gontiana; Composita? 143 

Guaiaci 2S6 

" Ammoniata 2S6 

Humuli 441 

Hydrastis 155 

Hyoscyami 860 

Iodinii 216 

Iodinii Composita; 216 

Jaborandi 469 

Jalapae 572 

Kino 273 

Lobelia? 481 

I.upulina? 441 

Nucis Vomica; 310 

Opii 421 

" Acetata 421 

" Camphorata 421 

Opii Deodorata 422 

Phospbori 102 

" ^Etheriale 108 

Pbysostigma? 472 

Phytolacca; 506 

Pilocarpi • 469 

Pulsatilla? 504 

Quassia; 148 

Ehei 563 

" et Senna? 563 

Sanguinaria? 2S9 

Scilla? 602 

Serpentaiia? 374, 151 

Stramonii 359 

Valeriana; 872 

" Ammoniata 872 

Veratri Viridis 499 

Tobacco 477 

Topical Remedies , 610 



63G 



INDEX OF EEMEDIES. 



PAGE 

Transfusion '. 13 

Tragaeanth 625 

Trimethylamine 467 

Trochisci : 

Trochisci Cubeba? 596 

Ferri Subcarbonatis 115 

Ipecacuanha; 553 

Morphia; et Ipecacuanha? 423 

Potassi Chloratis 178 

Santonini 584 

Turpentine 588 

Turpeth Mineral 228 

TJ 

ITImus 626 

Unguenta : 

Unguentum Acidi Carbolici 517 

Acidi Tannici 273 

Antimonii 264 

Belladonna? 348 

Benzoini 544 

Gallse 273 

Hydrargyri 228 

" Ammoniata 228 

" IodidiEubri 229 

" Nitratis 229 

" " Rubri 229 

" OxidiFlavi 228 

" " Eubri 228 

Iodinii 216 

" Compositum 216 

Plumbi Carbonatis 253 

" Iodidi 253 

Stramonil 359 

Tabaci 478 

Yeratria? 500 

Zinci Oxidi 259 

Urino-Genital Remedies 5SS 

Ustilgo Maidis 827 

TJva TJrsi 600 

V 

Valerian and its preparations 372 

Vapor-Bath 69 



PAGE 

Vegetable Acids 207 

Vegetable Diet 37 

Venesection 618 

Veratria 499 

Veratroidia 500 

Veratrum Album 499 

Veratrum Viride 499 

Vichy 193 

Vienna Paste 191 

Villate's Solution 262 

Vinegar 207 

Vina: 

Vinum Aloes • 570 

■ Antimonii 264 

Colchici Eadicis 281 

. " Seminis 2S1 

Ergotae 325 

Ipecacuanha? 553 

Opii 422 

Ehei 563 

Tabaci 478 

Vinum 392 

Portense 383 

Xericum 383 

w 

"Water ,. 54 

Wet Pack 53 

Whey-Cure 41 

Whisky 383 

Wine 392 

Woorara 457 

Worm-seed 5:5 

X 

Xanthoxylum 291 

Xanthoxylin 291 

Y 

Yellow Boot 155 

Z 

Zinc and its preparations 25S 

Zinci Phosphidum 103 

Zinci Sulphas 259 



CLINICAL INDEX. 



Abpominal Plktiiora: 
Aliment, water-freo food, 37; laxative diet, 47; 

grape cure, 37. 
Cathartics, Baline, -562; resin-bearing, 5CG; and 

hydragogue purgatives, 576. 
Saline Mineral Waters, 195, especially Saratoga, 

Vichy, and the purgative saline, generally. 

A BORTION : 

A urum, 240. The chloride, to avert the tendency 

to habitual abortion. 
Opium, 436. . To cheek uterine action, and Er- 
got, 333, to restrain haemorrhage. 
Al/ortifacients, ergot, savine, rue. aloes, pierotox- 
ine, apiol, pilocarpus, colocynth, the hydragogue 
cathartics, etc., all dangerous to lifo when used 
in sufficient quantity to produce abortion. 

Abscess : 
Belladonna plaster, S4S. Emplastrum ammo- 
niaci cum hydrargyro, 227. Leeches, 619. 
Nitrate of Silver in nitrous ether applied over 
inflamed area and adjacent region to abort in- 
flammation, 247. Tincture of Iodine as a coun- 
UT-irritant, and as an antiseptic injected into 
the sac of an abscess, 226. Carbolic Acid, 
525. Salicylic Acid, 539, Resorcin, 542, and Bo- 
racic Acid, 543, for antiseptic dressing. Sul- 
phides, 212, gr. i every few hours to abort ab- 
scess, or hasten the formation and extrusion of 
pus. Potass, permangan., 127, as a deodorant. 

Acidity : 
Mineral Acids, 90, before meals. Acid fermen- 
tation, with vomiting of pasty matter, sul- 
phurous acid, 210. During meals an acid wine 
(Rhine). For immediate relief, alkalies after 
meals, 1S3. The frequent use of alkalies en- 
hances the mischief. Lime-water, 1S9. Car- 
bonate of Ammonia, 200. Alkaline Mineral- 
tcaters, 193. Tannic Acid, 276, in pill form — 
m. j. glycerine to gr. iv of tannin. Carbolic 
Acid, 521, stops fermentation and eructations. 
Bismuth, 134, with carbolic acid, gives excel- 
lent results. The purified black Oxideof Man- 
ganese, 128, and Oxide of Silver, 244, are ser- 
viceable, acting as local sedatives and prevent- 
ing acid fermentation. Acetate of Lead, 256, 
Kino, 276, and Nun Vomica Tincture, 316, act 
in the same, and rather remove the causes than 
affect the acidity directly. 

Acne : . 
Phosphorus, 110. Even more effective and safer 
are the hypophosphites and phosphates. Ar- 



sinic, 141; sometimes beneficial, but on the 
whole disappointing. Bismuth, 184, is un ex- 
cellent topical application when there are heat 
and redness. Sublimed Sulphur, 210, applied 
as a powder to the eruption is one of the best 
applications. Alkaline lotions, when the skin 
is greasy and the sebaceous follicles full, are 
useless; for example, liquor potassa in rose- 
water, 190. Lotions of corrosive sublimate, 
238. Glycerine, 628, internally. 

Apy'namia : 
Alcohol, 391, is serviceable when it improves the 
appetite and digestion, when the tongue be- 
comes moist, aud when delirium subsides under 
its use. Brandy is the best form when bowels 
are relaxed ; whisky when there is constipation. 
A wine of good body and high bouquet in the 
weakness of sedentary occupations. Aliment, 
28, beef, milk, cod-liver oil. Bitters, especially 
calumba, 150, and liydrastia, 157, as a substi- 
tute for quinia. Eucalyptus, 154, for malarial 
adynamia, but especially the alkaloids of cin- 
chona, notably quinia, 167, gr. ij.— gr. v,ter'in 
die. Iron, 123, to stimulate digestion and pro- 
mote blood formation, with manganese. Chaly- 
beate springs, 182. Nux Vomica Tincture, 
31G, with capsicum in the case of inebriates. 
Coca 880, prevents waste, and favors construc- 
tive metamorphosis. 

After-pains : 
Chloral, 419, one of the most efficient remedies, 
but considerable doses necessary. Camphor, 
' 868, effective, with or without morphia. Gcl- 
sem ium, 466, also stops after-pains ; but, as large 
doses are necessary, safer remedies are prefer- 
able. Morphia and alropia, subcutaneously 
or by the stomach, very certain to relieve, 447. 
Oimicifuga, 847, affords some relief. 

Albuminuria : 
Milk cure, 41, especially buttermilk, 42. Iron, 
125, and the purgative chalybeate waters, 132 
for the anosmia. Arsenic, 144, for the intersti- 
tial changes in kidneys. Alkaline diuretics, 
1S5. Gallic acid. 278, especially Aitken's for- 
mula to restrain loss of albumen. 

Alcoholism : 
Bromides, 447, especially for the " horrors," in 3 
doses. Capsicum, 598, for its stomachic tonio 
and hj'pnotic qualities. Chloral, 418, very effi- 
cient in the acute form, but caution is required 
in old drunkards. Opium, 435, but cautiously. 



638 



CLINICAL INDEX. 



Zinc Oxide, 262, for the chronic state, with 
piperine or capsicum. Cinchona, 166, 173, es- 
pecially the C. Kubra fluid extract. Lupu- 
line, 441, fluid extract with capsicum ; good sub- 
stitute for alcoholic stimulants. Picrotoxine, 
325, for the muscular tremors. Mux Vomica, 
816, nerve and stomachic tonic. 

Amaurosis : 
Strychnia, 319, hypodermieally, curative in func- 
tional disease caused by tobacco, alcoholic ex- 
cess, etc. 

Amenoerhcea : 
Aconite, 499, for sudden suppression due to cold. 
Aloes when due to anaemia and torpor. Iron, 
125, when anaemia is the cause, may be given 
with nerve stimulants, as nux vomica. Cha- 
lybeate Waters, 132. Apiol, 604, and Hydro- 
piper, 605, when there is functional inactivity 
of ovaries, preceded by a chalybeate course, by 
aloes, apiol being given just before the period 
for several days. Arsenic, 144, as a reconstit- 
uent, combined with iron. Aurum, 240, a 
stimulant of the menstrual function. Asa- 
fuetida, 371, for the nervous disturbance and as 
an ovarian stimulant. Electricity, 309, fara- 
dic and static; very efficient to start the flow 
when suitable preparation has been made. Er- 
got, 334, is useful when plethora exists. Hue, 
006, and Savin, 607, are active stimulants, to 
be given with great caution. Pulsatilla, 505, 
used under the same circumstances as aconite 
in sudden arrest of flow. 

Anaemia : 

Compressed Air, 77. Oxygen,5H. Iron, 120. 
Arsenic, 142, an adjunct of iron, or when the 
latter can not be borne. Pepsin, S3, and Pan- 
creatine, 85, to aid the primary assimilation. 
Zacto-phosphate of Zime,113, a material need- 
ed in the anaemia of lactation and of suppura- 
tion. Manganese, 127, of use when associated 
with iron. Galvanization, central, 806, to 
stimulate the functions of organic life. Wines, 
395, especially the red wines with good body. 

Anesthetics : 
Kules for administration, 407. Morphia, subcu- 
taneously by the method of Bernard, 407, facili- 
tates the inhalation, lessens the dangers, and 
prolongs the anaesthetic stage with a less quan- 
tity of the anaesthetic. Whisky, 407, adminis- 
tered before inhalation sustains the heart and 
prolongs the narcosis. Means of restoration, 
408, depressing head, drawing out tongue, arti- 
ficial respiration, inhalation of ammonia, or in- 
travenous injection of the same, faradization of 
chest muscles, electropuncture of the heart, etc. 

Aneurism : 
Aliment, 36, 41, denutrition cure. Tufnell's plan, 
36. Barium Chloride, 206, acts by raising the 
arterial tension, and has been used successfully. 
Iodides, 219, in full doses, relieve pain, and 
promote coagulation of blood in the sac. Ace- 
tate of Lead, 257, depresses the heart and raises 
the arterial tension. Veratruni Viride, 502, 
slows the circulation, and thus facilitates coagu- 
lation in the sac. Aconite and other arterial 
sedatives act similarly; but their action must 



be aided by a proper diet and absolute recum- 
bency. Ergot, 332, especially ergotin subcu- 
taneously, has been very effective. Galvano- 
puncture, 30S, has but rarely succeeded. 
Angina Pectoris : 

Amyl Nitrite, 491, by Inhalation, affords prompt 
relief in cases characterized by elevated arterial 
tension, but must be used with caution when 
arteries are atheromatous and heart is fatty. 
Nitro-glycerine, 493, acts similarly but more 
slowly, and is more manageable. Arsenic, 144, 
in full doses, is very efficient as a means of pre- 
vention. Ether, 400, in small quantity by in- 
halation, may abort a mild attack. 
Antidotes : 

For the Mineral Acids, 8S. Alkalies, soda, lime- 
water, soap, and protectives, as oil, mucilage, 
etc. For the systemic depression : alcohol, 
opium, and especially carbonate of ammonia. 

For Phosphorus, 102. Emetic of sulphate of cop- 
per, French turpentine, or old, unrectified tur- 
pentine, hydrated magnesia, laxatives, trans- 
fusion. Oils and fats aid the absorption of 
phosphorus, but mucilaginous protectives are 
useful. 

For Arsenic, 136. Hydrated sesquioxide of iron, 
dialyzed iron, hydrated magnesia, emetics, the 
stomach-pump; opium and alcoholic stimu- 
lants for the systemic depression. 

For the Caustic Alkalies, 179. Diluted acetic 
acid, vinegar, soap, oil ; opium and stimulants 
for the systemic depression. 

For Barium, 205. Emetics, protectives, hydrat- 
ed magnesia, tannin, especially diluted sulphuric 
acid, and nitrite of amyl, and nitro-glycerine to 
counteract the elevated arterial tension. 

For Sulphurous Acid and Sulphites, 209, and 
the Sulphides, 211. Weak acids, chlorine-wa- 
ter, sulphate of iron, common salt, etc. 

For Iodine and its poisonous compounds, 217. 
Starch is the antidote for iodine ; but, as the 
iodide of starch is not without power, emetics 
should also be given. Albumen, starch, lime- 
water, tannin, soap, etc., should be used in poi- 
soning by iodides, and free emesis should be in- 
duced. 

For Mercury and its compounds, 228. Albu- 
men, the carbonated alkalies, tannin, lime-watt- r. 
should be administered freely. Emetics should 
be given. For the usual systemic symptoms, 
opium, alcoholic stimulants, etc. 

For Gold and its Chlorides, 239. Same as for 
mercury. 

For Silver, 241. Common salt freely, albumen, 
tannin, and emetics. 

For Copper, 249, and Zinc, 258. Albumen, tan- 
nin, lime-water, soap, oil, and mucilage; and 
the usual systemic remedies. 

For Lead, 253. Diluted sulphuric acid, alum, 
epsom salts, milk ; emetics and purgatives, and 
iodides and bromides to secure elimination. 

For Antimony, 263. The vegetable astringents, 
tannin, albumen, oil, mucilage, and opium and 
stimulants to counteract the depression. 
For Nux Vomica and its Alkaloids, 317. Chlo- 
ral, ether and chloroform, gelsemium, bromide 



CLINICAL INDEX. 



C39 



of potassium, are the physiological antagonists; 
tannin la a chemical antidote. 

For Picrotoxine, 323. The physiological an- 
tagonists and the antidotes are the same as for 
strychnia. 

For Digitalis, 886. Aconite, saponaria, ainyl ni- 
trite, and nitroglycerine are the physiological 
antagonists; tanuin, sulphate, and chloride of 
iron are chemical antidotes. 

For Belladonna and its alkaloid Atropia, 849. 
Opium or morphia, physostigma or eserine, and 
pilocarpine are the most efficient antagonists. 
Tho caustic alkalies destroy the active prin- 
ciple, but the available chemical antidotes are 
tannin, compound solution of iodine, charcoal, 
etc. 

For Stramonium, Ifyoscyamus, and Duboisia. 
The antagonists and chemical antidotes are tho 
same as for belladonna. 

For Chloroform— By the stomach, 401. Tho 
stomach-pump, oil and mucilage, atropia, fara- 
ilism, artificial respiration, and cold affusion. 
By inhalation, 407. Nelaton's method (inver- 
sion of tho body), drawing out the tongue, arti- 
ficial respiration, faradism, ammonia by in- 
halation and intravenous injection, amyl ni- 
trite by inhalation, subcutaneous injection of 
tincture of digitalis. Oxygen, 514, by inhala- 
tion. 

For Chloral, 414. Ammonia, atropia, galvanism 
and heat, to overcome tho cardiac depression. 
Strychnia is the antagonist of Liebreich, but 
its range is limited. Eserine, to a slight extent, 
is physiologically opposed. 

For Opium. 424. The stomach-pump, or emetics 
(bicarbonate of sodium, followed by tartaric 
acid, has acted favorably) ; cold affusion, faradi- 
zation, and artificial respiration, when the res- 
piration flags ; belladonna, or atropia subcuta- 
neously, has acted favorably in numerous cases ; 
caffein injected, or black coffee. 

For Conium, 454. Chemically the caustic alka- 
lies and tannic acid are antidotes; emetics or 
the stomach-pump, cold affusion, artificial respi- 
ration. Atropia and strychnia, subcutaneously, 
to counteract the respiratory depression. 

For Curara, or Woorara, 453. Canstic alkalies 
and tannin act chemically ; artificial respiration 
is of tho highest importance ; atropia and 
strychnia counteract tho respiratory failure. 
Cold affusion and emetics, or the stomach- 
pump, are necessary. 

For Gelsemium, 408. Chemically caustic alka- 
lies and tannic acid. Emetics, warmth, ammonia, 
faradization of chest-muscles, artificial respira- 
tion, and morphia, subcutaneously, are the im- 
portant measures. 

For Pilocarpus, 409. The persalts of iron and 
the salts of the metals are chemically antidotal. 
Atropia is, in a very complete degree, the phys- 
iological antagonist ; cardiac stimulants, as 
ammonia and alcohol, antagonize tho heart's 
■weakness. 

For Physostigma, 472. The vegetable astrin- 
gents and tannin, chemical antidotes. Physio- 
logical antagonists are, atropia to a considerable 



extent— chloral, apparently, more completely. 
Faradization of chest-ninscles and artificial 
respiration are important measures. Emetics 
should not be omitted. 

For Tobacco or Xicotine, 47-t. Emetics or 
stomach-pump. Taunin, compound solution 
of Iodine, chemical antidotes. Ammonia, 
brandy, atropia, and strychnia to overcomo 
failure of respiration also, artili ial respiration. 
cold affusion. 

For Hydrocyanic Acid and Cyanide of Potas- 
sium, 481,488. Cold allusion to the spine, arti- 
ficial respiration, and the injection of atropia, 
are the best expedients. Emetics should bo 
given if there is time. 

For Amyl Xitrite and Nitro-glycerine, 4S9, 
491. Ammonia, cold affusion, and artificial 
respiration, stryclinia and atropia subcuta- 
neously, also ergot, a true physiological antago- 
nist. 

For Aconite and Yeratrum Yiride, 495, 5C0. 
Ammonia, alcohol, artificial respiration, heat, 
atropia, or morphia, subcutaneously ; also digi- 
talis. 

For Muscarine, £09. A complete antagonism 
exists between atropia and muscarine ; also, 
digitaliue and eserine are antagonists. 

For Carbolic Acid, 51S. Saccharatc of lime, or 
lime, is a chemical antidote. Oils and glycerine 
must not be given, but vegetable demulcents 
used freely. Atropia is a physiological antago- 
nist of great value. Emetics should be used, 
and diluents. 

For Salicylic Acid and Resorcin, 530, 540. 
Arterial and respiratory stimulants prevent the 
cardiac depression, especially atropia. 

For the Uydragogue Cathartics, 570. Demul- 
cents, opium, and stimulants. 

For Turpentine, 58S. Emetics, diluents, and 
demulcents. Opium is the most important 
remedy to counteract the local irritation and 
the cerebral effects. 

For Ha cine, 600, and Cantharides, 60S. Emet- 
ics and demulcents. Opium to counteract the 
depression and local inflammation ; also, stimu- 
lants and atropia for the cardiac depression. 
.Antipyretics : 

Quinia, 168, first in importance, but must bo 
given in full doses. Eucalyptus, 155, useful 
in chronic malarial poisoning. Digitalis, 342, 
chiefly useful as an adjunct to qninia. Sali- 
cylic Acid, or salicylates, 535, active and cer- 
tain antipyretics. Resorcin, 541, a new and 
valuable agent to reduce fever heat. Cold 
Baths, 60, 62, the most powerful means of 
lowering temperature Pilocarpus, 471, re- 
duces fever after a preliminary stimulation. Of 
lesser importance are Aconite, 497, Gelsemium, 
465, and Phytolacca, 507. 
Antiseptics : 

Carbolic Acid, 523, Salicylic Acid, 535, Boracic 
Add, 543, Resorcin, 541, Quinia, 16S". are tho 
most important for tho antiseptic method. 
Thymol, 547, Myrtol, 548, Oxygen, 514, Chlo- 
rine, 515, Bromine, 516, Sulphurous Acid, 
210, etc., are of minor importance. 



040 



CLINICAL INDEX. 



Aphonia : 
Atropia, 852, is certain, nearly, in hysterical 
cases, if given to induce some obvious consti- 
tutional symptoms. Nitric Acid, 92, is very 
effective in the hoarseness of singers, when the 
aphonia is reflex from stomach disorder, and in 
fatigue of vocal cords. Electricity, 303, by an 
intralaryngeal electrode, cures, usually, paresis 
of the vocal cords. 

ApirrniB : 
Bismuth, 133, in powder directly to the ulcers. 
Coptis, 150, the infusion as a topical applica- 
tion. Chlorate of Potassium, li3, probably 
the most effective remedy, locally, and by the 
stomach ; full doses are necessary. Iodide of 
Potassium, 219, in solution, an excellent top- 
ical application. Quinia, 166, highly useful as 
a tonic. Muriatic Acid, 69, a local applica- 
tion to ulcers, formerly more employed than at 
present. Sulphurous Acid, 209, well diluted, 
in the form of spray. Carbolic Acid, 524, 
pure, applied to ulcers, an anesthetic and 
alterant. 

Apoplexy. (See H.emorriiage, Cerebral.) 

Arthritis, Chronic Kheumatic : 
Alkalies, 190, especially lithium. Iodide of Po- 
tassium, 223. Cimicifuga, 347. Salicylates, 
53S ; especially in debilitated subjects, Salicy- 
late of CincJionidia. Arsenic, 145, persist- 
ently used in small doses. Cod-liver Oil, 100, 
with or without the phosphates. 

Ascarides : 

Quassia, 151 , also Eucalyptus, 154, an infusion 
as a rectal injection, or by irrigation of the 
bowel. Carbolic Acid, 524, is an efficient but 
unsafe parasiticide when injected in the rectum. 
Iron, 120, the sirup of the iodide, by the stom- 
ach to prevent reproduction, and the tincture 
by rectal injection. Santonine, 584, at night, 
with or without calomel, and a laxative in the 
morning. Enema Aloes, 5S1. Hydrocyanic 
Acid, 4S6, for lumbrieoides. Salicylic Acid, 
534, by enema and by stomach. Myrtol, 548. 

Ascites : 
Copaiba 'Resin, 595, has proved very efficient as 
a diuretic. Pilocarpine, 471, very service- 
able when given to produce free diaphoresis. 
Jalap, 572, in the form of the compound pow- 
der, most useful as a hydragogue cathartic. 
Elaterium, 579, also a hydragogue of great 
power ; must be given cautiously, and not at 
all when gastro-iutestinal irritation exists. 
Remedies are more active when aided by a 
milk diet, 41, or by dry diet, 37. 

Asthma : 
Air, compressed, 77. Oxygen, 514, pure or di- 
luted by inhalation. Amyl Nitrite, 490, by 
inhalation, or Nitro-glycerine, 498, by the 
stomach. Arsenic, 142, by the stomach, as a 
prophylactic, or by smoking in cigarettes. 
Bromides, 451, relieve in purely spasmodic 
asthma, but soon lose their effect. Chloral, 
419, may arrest the paroxysms, but danger of 
chloral habit. Chloroform, 402, by inhalation 
dropped on warm water, relieves, but a habit 
is quickly formed. Last two remedies are | 



dangerous in weak heart. Ether, 409, is safer 
and equally efficient by inhalation. Belladon- 
na, 352, in pastiles with stramonium and other 
narcotics, gives temporary relief, but Atropia, 
hypodermatically, is more efficient. Morphia, 
437, and atropia subcutaneously give more 
decided and lasting relief than any other reme- 
dies. Grindelia, 506, is a most useful remedy, 
next in value as a means of immediate relief to 
morphia and atropia. Iodide of Potassium, 
220, in full doses, succeeds remarkably in some 
cases. Quinia, 174, as a tonic after the acute 
symptoms and as a prophylactic in the interval. 
Strychnia, 31S, is indicated when there is 
weakness of respiratory muscles. Galvaniza- 
tion, 305, of the pneumogastric and cervical 
sympathetic relieves the spasmodic difficulty of 
breathing, and sometimes effects a cure, and 
faradization of the chest-muscles has lately 
been reported successful in effecting a cure. 
Tartar Emetic, 267, and Lobelia, 483, carried 
to slight nausea in cases of deficient secretion 
of bronchial mucus. Pilocarpus, 471, in hu- 
mid A. 

Astigmatism : 
Atropia, 355, a weak solution to facilitate exam- 
ination. Dubowia, 365, a substitute. Eserine, 
476, 477, in some cases. 

Atheroma of the Vessels: 
Arsenic, 143, indicated when eyes are puffy, 
breathing short, and ankles swollen. Phos- 
phorus, 109, in minute doses for the weak- 
ness and mental failure associated therewith, 
with or without Cod-liver Oil, 100, which may 
also be advantageously combined with phos- 
phates and hypophosphites. Quinia, 173, is of 
great service, administered in a full dose daily 
for a time. 

Bed-sores : 
Alcohol, 391, a wash to skin. Alum, 272, with 
tincture of camphor and whites of eggs, a good 
topical application. Copaiba, 595, and Castor- 
Oil, equal parts, one of the best. A galvanic 
couplet, zinc and silver, connected with a cop- 
per wire, has been used with success. 

Biliary Calculi. (See Calculi.) 

Biliousness: 
Acids, Mineral, 90, before meals in acid indiges- 
tion. Hydrochloric acid and pepsin after 
meals in atonic dyspepsia. Alkalies, and their 
laxative 6alts, 183, and Alkaline Mineral- 
waters, 194, when the uric acid is in excess. 
Aloes and the resin-bearing cathartics, 566, to 
promote biliary evacuations. Calomel and blue 
pill, 566, in small quantity as laxatives merely. 
Muriate of Ammonia, 202. Manganese, 129, 
in gouty subjects. Iodide of Ammonium, or 
iodine, 221, 222, in the biliousness of the mala- 
rial cachexia. Hydrastis, 156, Stillingia, 1i~. 
and the bitters, also, Tincture of Nux Vomica, 
817, after the action of saline or resinous cathar- 
tics. Milk LHet, 40, 41 , 50, of high importance. 

Bites of Venomous Snakes : 
Ammonia, 203, Bromine, 517, locally to the 
wound. Alcoholic Stimulants, 389. Chlo- 
rinated Lime, 516. 



CLINICAL IXDEX. 



641 



Bladder, Catarrh of- 

Alkalies, ls">, after meals, when urine Is acid. 

Benzoate of Ammonia, 645, when urine la 

alkaline. Copaiba, 595, (^ubebs, 597. Buchu, 

600, Juniper, 591), anil other urino-gciiituls, are 

useful, but liable to damage kidneys. Ounfllar- 

t'des Tincture, 909, very efficient in small 
d0SC9. Eucalyptus, l.Vl, and Turpentine, 692, 
Quinia, 174, very beuelicial when associated 
with prostatic disease. 

Bladder, Irritability of : 
Belladonna, 854, of special utility in nocturnal 
incontinence, but must be carried to the pro- 
duction of physiological efieota. cantharides 
Tincture, 609, sometimes succeeds remarkably 
in irritable bladder of women. Aqua-punc- 
ture, 01T. often curative. When urino is acid, 
Alkalies, 185; when alkaline, Benzoate of Am- 
monia, 545. 

Boils : 
Arsenic; 144, long continued f>r a succession of 
boils. Nitrate of Silver, 240, dissolved in 
nitrous ether, and painted on early to abort 
boils. Sulphides, 212, in small doses frequent- 
ly, cither stop formation or terminate by ex- 
trusion of pus. Sulphurous Waters, 218, 
act in same way. Phosphates, 118, suitable 
tonics 

Bone Diseases ; Softening of Bone : 
Carbonate and Phosphate of Lime 113, 189, 
materials necessary. Phosphorus, 109, to pro- 
mote formation of bony tissue. Phosphates, 
118, to improve tissue formation in general. 
Cod-liver Oil, 100, in combination. Chloride 
of Calcium, 189, in strumous subjects. (See 
also Caries, Kickets.) 

Breath, Fottl : 
Chlorine- Water, 515, properly diluted. Car- 
bolic Acid, 522, in diluto solution, as a mouth- 
wash, and by the stomach. Potassa, Perman- 
gaiiate, 190., in rose-water as a mouth-wash. 
Benzoic Acid, 544. 

BRiGnT's Disease : 
Milk Cure, 41, 42, has been very successful, es- 
pecially an exclusive skim-milk diet, or a diet 
composed largely of milk. Water, 00, and 
large draughts of weak alkaline waters. Bitar- 
trate of Potassa,1S5, as lemonade, drunk freely 
as a diuretic. Digitalis, 844, the infusion for 
dropsy. Iodide of Potassium, 221, in. cases of 
chronic kind, aDd especially if a syphilitic taint 
is known to bo the cause. Iron, 125, the tinct- 
ure of the chloride, well diluted, or-in Basham's 
mixture, to stimulate the kidneys and to re- 
lieve the accompanying anaemia. Jaborandi, 
471, highly useful in many cases of urajmia. 
Aurum, 241, in chronic interstitial nephritis 
and amyloid kidney. Cantharides, 609, Euca- 
lyptus, 154, and other urino-genitals, but are 
doubtful. Xitro-glycerine, 494, has had some 
remarkable successes. 

Bronchitis, Acute : 

Muscarine, 512, at the onset of the disease may 

arrest. Aconite, 497, in small dose frequently. 

Tartar Emetic, 266, in moderate quantity, 

with or without morphia. Nitric Acid dilute, 

42 



87, Cimicifuga, C40, an expectorant, may bo 
combined with opium and aconite. Carbonate 
of Ammonia, 208, if secretion is viscid and 
there is depression. Sangvinaria, 259, and 
Lobelia, 4HS, nauseating expectorants, best 
given with opium. Morphia, or Dover's 
Poicder, with quinia, 167, may abort if given 
early enough. Pilocarpus, 471. often highly 
useful at the beginning. For mild cases, Sirup 
of Seville, 608, or the compound sirup, 603, 
with Paregoric, makes a useful combination. 
Ipecac, 5"i5, as expectorant. 
Bronchitis, Capillary : 

Iodides, 220, diminish the vicidity of the secre- 
tion, and thus lessen one of the chief dangers. 
Carbonate of Ammonia, 203, acts similarly, 
and is indicated when depression comes on. 
Serpentaria, 152,375, a stimulating cxpecto 
rant, may bo given with ammonia. Turpen- 
tine, 592, when the capillary circulation lan- 
guishes; Camphor, 868, also, under the same 
circumstances. Emetics are highly useful, the 
Snbsulphate of Mercury, 550, Alum, 550, and 
Apomorphia, 552, being the principal. Pilo 
carpus. 471, when there is much secretion. 
Bronchitis, Chronic : 

Koumiss, 41, a valuable nutrient. Cod-liver Oil, 
99. Iron, 124, especially the mistura ferri 
composita. Chloride of Ammonium, 202, 
combined with stimulating expectorants, as 
Eucalyptus, 154, or Serpentaria, 875, or San- 
guinaria, 290. The Iodides, 220, especially 
the iodide of ammonium, is serviceable in com- 
bination with the expectorants just named. 
Morphia, 438, or some preparation of opium, is 
indispensable to quiet cough. Strychnia, 319, 
and the sirup of the phosphate of iron, quinia, 
and strychnia, is a valuable respiratory stimu- 
lant. Strychnia is the best remedy to check 
the reflex vomiting. Inhalations of Sulphurous 
Acid, in spray or gas, 210, of Carbolic Acid, 
522, and of the Benzoates, 546, are very useful. 
Grindelia, 506, a valuable expectorant, espe- 
cially when the cough is troublesome. Copaiba, 
595, and Cubeb, 597. 
BRONcnoRRncEA : 

Eucalyptus, 154. Turpentine, 592, and the 
stimulating expectorants mentioned under 
chronic bronchitis. Carbolic Acid, 522, inter- 
nally and by spray. Grindelia, 506. Muriate 
and Carbonate of Ammonia, 203. Cubeb, 597 
Copaiba, 595. Sulphurous Acid, spray, 210. 
Benzoin, inhalation, 544. Myrtol, 54S, antisep- 
tic ; eliminated by the lungs. Cod-liver Oil, 99. 
Alcoholic Stimulants, 891. Oxygen, inhala- 
tions. Iodides, 220. Quinia, 167, and the 
Phosphates as restoratives, 100. 
Burns and Scalds : 

Carbonate of Soda, 191, in saturated solution to 
relieve pain. Boracic Acid, 543, most useful 
in Mr. Lister's hands. Carbonate of Lead, 
257, painted on. Turpentine, 593, mixed with 
basilicou ointment. Salicylic Acid, 539. Car- 
bolic Acid, 525, one per cent, solution relieves 
pain and prevents suppuration. Collodion, 
624, the flexile for slight burns. 



642 



CLINICAL INDEX. 



Cachexia: 
Aliment, 49, of first importance. Air, 71. Mas- 
sage, 73. Oils and Fats, 95, and oil inunctions. 
Iron, 122, and Chalybeate Waters, 132. Man- 
ganese, 123, especially Sirup of the Iodides 
of Iron and Manganese. Arsenic,\i2. Phos- 
phates, 113. The Simple Sitters, 148. -ffu- 
calyptus, 155. Hydrastis, 157, Quinia. Cod- 
liver Oil, 98. 

Calculi, Biliaky: 
Aliment, 39. Starches, sweets, and especially fats 
should be avoided. Alkaline Mineral- Waters, 
194, highly useful. Phosphate of Soda, 113, 
persistently used. Turpentine, 590, remedy 
of Durand. For the paroxysms, see Colic. 

Calculi, Kenal : 
Alkalies, 141, 146, when the calculi are uric, the 
potash, and not the soda salts. Also, Alkaline 
Mineral-Waters, 195, Vichy, Bethesda, etc. 
Benzoate of Ammonia, 545, for the solution of 
phosphatic calculi. Very long-continued use of 
the solvent necessary. Boroeitrate of Mag- 
nesia, 543, solvent for uric acid calculi. Tar- 
troborate of Potassium, 543, probably still 
more efficient. 

Cancer : 
Arsenic, 141, 146, relieves the pain and retards 
the growth of carcinoma of the stomach, and 
also of epithelioma. Bismuth, 134, relieves 
the vomiting in cancer of the stomach; also, 
Carbolic, Acid, 524, which, also, injected be- 
neath a cancer mass and applied to the ulcer- 
ated surface, retards the growth and allays pain. 
Potassa Chlorate, 191, applied in powder alters 
the ulcerated surface. Iodoform, 225, and Sali- 
cylic Acid, 539, also in powder to the surface 
of the cancer. Zinc Chloride and Sulphate 
dried, 262, are efficient caustics. Potassa 
Fusa, 191, Chromic- Acid, 621, and Bromine, 
517, also active escharotics for the destruction 
of morbid growths. 

Caries : 
Cod-liver Oil, 100, to promote constructive met- 
amorphosis. Phosphates, 113, and Carbonate 
of Lime, 189, furnish needed materials. Chlo- 
ride of Calcium*, 1S9, is useful in the strumous 
cachexia. Phosphorus, 109, promotes bone 
formation. Villatte's solution used to dissolve 
carious bone. 

Catarrh, Acute ; Common Cold : 
Aconite, 497, for the preliminary fever, with 
■Belladonna, when secretion is excessive. 
Quinia and Morphia, 174, 437, may, at the 
outset, abort an attack. Ipecac, especially the 
fluid extract, 555, alone or in combination -with 
opium and aconite. Tartar Emetic, 266, in 
minute doses with morphia is very useful. 
Dover's Powder, 437, at the inception may ar- 
rest the attack. Iodides, 220, a small dose 
very frequently, and Inhalations of Iodine, 
221. Ammonia, 203, carefully inhaled at the 
outset of the disease. Pulsatilla, 505, acts 
similarly to aconite, but is contraindicated if 
gastro-intestinal irritation exist. 

Catarrh, Broncho-Pulmonary : 
Air, compressed, 77. Alum, 269, by insufflation. 



Aconite, 497, when attack is recent. Bella- 
donna, 352, when secretion is profuse. Eu- 
calyptus, 154, Hydrastis, 156, Sanguinaria, 
290, and Prunus Virginia, 152, after the 
acute symptoms have subsided. Also, Cubeb, 
596, Copaiba, 595, Turpentine, 592, Carbolic 
Acid, 522, of great value by spray inhala- 
tion. 

Catarrh, Chronic Nasal: 
Alum, 271, in powder by insufflation. Iodoform 
and Tannin, 224, also applied in powder by in- 
sufflation. Iodine, 221, in vapor inhaled ; also 
Bromine, 516, but it must be inhaled very cau- 
tiously. Sanguinaria, 290, the tincture in- 
ternally and the powder locally. Cubeb, 596, 
in powder by insufflation and troches. 

Catarrh, Gastric. (See Gastric Catarrh.) 

Catarrh, Intestinal. (See Dysentery and Di- 
arrhoea.) 

Catarrh, Genito-Urinary. (See Bladder, Ca- 
tarrh of, Cystitis, Gonorrhcea, Leucokrikba, 

PROSTORRnCEA, ENDOMETRITIS, etc.) 

Cerebral Anemia : 
Iron, 123, and Chalybeate Mineral- Waters, 132. 
Galvanism, 301, by transverse applications. 
Phosphorus, 109, and Phosphates, 114, Quinia, 
173, Strychnia, 318, and the cerebral excitants, 
Caffein, 382, Guarana, 3S2, etc. Arsenic, 
143, is highly efficient in some hypochondriacal 
cases; also, Aurum, 241. Amyl Nitrite, 490. 
Nitro-glycerine, 494, and Ammonia, 203, af- 
ford relief in sudden attacks. 

Cerebral Congestion : 
Aconite, 499, Cold Douche, 63, alternate hot and 
cold applications. Bromides, 447, highly use- 
ful. Ergot, 333, Gelsemium, 465, Hydrocy- 
anic Acid, 4S7, and the arterial sedatives, Ve- 
ratrum Viride, 502, Digitalis, 843, etc. Gal- 
vanization of the Cervical Sympathetic, 302. 
Venesection, 619, is a suitable remedy in cases 
threatening rupture of vessels. Active Cathar- 
tics, 558, Colchicum, 2S3, lessen blood pressure 
and act by derivation. 

Cerebro-Spinal Meningitis : 
Aconite, Tincture, 498, carried to arterial de- 
pression before exudations. Ergot, 833, also, 
• for first stage or period of congestion and irri- 
tation. Gelsemium, Fluid Extract, 465, for 
same period. Opium, 434, is the most effective 
remedy. Quinia, 169, full cinchonism at the 
onset of the disease. Cold Baths, 60, 62, for 
hyperpyrexia. 

Chancre. (See Syphilis.) 
Bromine, 516, Chromic Acid, 621, Nitric Acid, 
94, and Acid Nitrate of Mercury, 237, efficient 
escharotics for the destruction of chancre. Iodo- 
form, 225, with or without Thymol, 547, an 
excellent application dusted over sore. Car- 
bolic Acid, 524, applied pure in mild cases 
Iodide of Iron, 122, internally in cases of sys- 
temic depression or sloughing phagedena. 
Chlorate of Potassa, 191, in powder is also an 
excellent local application. 

Chilblains : 

Turpentine, 593, Tincture of Iodine, 224, Car- 
bolic Acid, 524, with iodine and tannin. Sul- 



CLINICAL INDEX. 



043 



phwout Aci i. dilated with jlyoerli 
an excellent application. 

ClU.or.nl ;. KM Nl- ANTIDOTES, NaB- 

I- ) 
ClILOBOMS : 

</.-. 143, as an adjunct to, or substitute for, 
iron. Oxygen, 514, inhaled. Iron. 121. with or 
withoat arsenic ; with aloes if constipation 
exist. Chdl ylnate Springs, 189. HftUiage, 

BO, oil Inunctions, 88, and faradization. Gal- 

ninizntiun, 806, to central nervous system, 
i 'omiea, or strychnia, 817, stiuiulates the 
blood-making organs; may be combined with 
iron. Pepsin, 84, Pancreatine, 84, improve 
digestion. 

CaOLBBA Asiatic a : 
Acetate of Lead, 256, an excellent astringent, 
usually given with opium and camphor. i 'ni'n- 
phor, 807, the saturated tincture. Carbolic 
581, with or without Iodine. Chloral, 
417, is highly effective by subcutaneous injec- 
tion ; usually combined with morphia. Chlo- 
roform, a few drops frequently to stop vomit- 
ing-. Opium, 481, especially useful to arrest 
preliminary diarrhoea. Calomel. 233, minute 
doses will sometimes stop vomiting. Alcohol, 
859, as iced brandy or champagne to arrest 
vomiting and stimulate the heart. Sulphuric 
Acid, 01, with opium tincture, an excellent I 
remedy for cholera diarrhoea. Arsenic, 141, i 
Fowler's solution with opium, sometimes val- 
uable. Strychnia, 817, has been used with 
success in some epidemics. Atropia, 352, to 
stimulate the heart in cholera asphyxia. Intra- 
venous Injection of Salines, 12, in the algid 
stage, and of Milk, 16. 

Cholera Morbus: 
Morphia and Atropia, 431, hypodermatieally, 
the most efficient remedy. Chloral, 417, with 
morphia if cramps occur. Carbolic Acid and 
Bttm nth. 521, in an emulsion together, are suf- 
ficient in mild cases. The remedies for Chol- 
era A., also. Cajepul Oil, 54$. 

Cholera Infantum : 
Aliment, 41, 42, is of the highest importance. 
Carbolic Acid, 520. with or without bismuth, 
is very effective. Bist?iuth, 134, is frequently 
prescribed in an emulsion. OxideofZinc, 861. 
Calomel, 238, in minute doses, arrests vomit- 
ing. Sulphate of Copper, 251, is an effective 
remedy, but only the smallest doses are admis- 
sible. Bromide of Potassium, 446. is highly 
useful in cases characterized by nervous irrita- 
bility and feverishness. Ipecacuanha, 55fi, is 
a desirable remedy when the stools assume a 
dysenteric character. Brandy, 389, renders 
important service in most cases, but full doses 
are necessary. Camphor is indicated when de- 
pression is marked ; it may be given in milk. 
Nitrate of Silr, r, 2 14. beneficial after the acute 
symptoms. Opium, 432, must be given with 
great caution. 

Chordee; 
Camphor, 863, successful if given in sufficient 
quantity; may be administered with lactu- 
carium. Cantharides Tincture, COS, in small 



dose is said to be useful. Morphia and Alro- 
jiiti, 44", Bnbontaneonsly is the most certain. 
Colchicum, 288, in a nightly dose will su 
Tartar Emetic, 2f>7, will relieve if carried to 
nausea. Tobacco, Wine of, 4S1, a few drops at 
bed hour. 

CnoREA : 

Water, G-t, cold affusion and cold baths. Iron, 
124, especially subearbonato for the condition 
of nna?mia and nmenorrhcea. Cod-linr Oil, 
100, when the nutrition is poor. Arsenic, 143, 
one of the most certain remedies, but large 
doses are required, and well borne. Strychnin, 
818, and especially Picrotoxine, 824, in full 
doses when the nervous element is predomi- 
nant. Cimicifurja, 347, useful in cases with 
menstrual derangement. Conivm, 455, espe- 
cially eueous con ii, has been strongly urged by 
Harley. Morphia, 4-36, in the large doses 
readily • borne, and Chloral, 419, especially at 
night, are highly useful. Static Electricity, 
809, has lately been revived. Chloride of Cal- 
cium, ISO, has done good in strumous subjects. 
Cannabis Indica, 378. 

Cirrhosis : 
Iodides, 219, with or without arsenic, are useful 
in first stage. Phosphate of Soda, 114, per- 
sistently administered, of real value if com- 
menced early. Chloride of Gold, 241, has 
seemed tohavc curative power if given in time. 
Arsenic, 142, and Phosphates, especially Phos- 
phate of Soda, 114, appear also to retard over- 
growth of connective tissue. Stillingia, 287, 
and Hydrastis, 156, in incipient disease, sec- 
ondary to intestinal catarrh. 

Colic : 
Asafoetida, 871, in the flatulent colic of infants. 
Chloroform, 401, useful in flatulent colic, and 
in hepatic, a few drops frequently. Ether, 363, 
400, internally and by inhalation. Camphor, 
367, a few drops of the saturated tincture fre- 
quently. Infusum Tabaci, 479, as an enema, 
effective but dangerous. Morphia, 432, hypo- 
dermatically, the most prompt and successful 
remedy. 

Colica Pictonum : 
Alum, 270, overcomes the constipation with suc- 
cess ; may be given with dilute sulphuric acid. 
Sulphuric Acid, 93, very dilute in " lemonade," 
as prophylactic and as a curative agent. Mor- 
phia, 432, subcutaneously, relieves pain most 
quickly. Iodides, 22-3, and Bromides, 447, to 
cause excretion of lead. Sulphate of Mag- 
nesia, 563, to overcome constipation. 

Cone, Hepatic : 
For the pain — Morphia and Atropia, 440, subcu- 
taneously. Spirit of Chloroform, 401, Ether, 
internally and by inhalation. J¥itro-glycerine, 
493, and Amyl Nitrite. For the calculi— Ali- 
ment, 41, Phosphate of Soda, 113. Chloro- 
form, 401, a few drops ter die persistently 
used. Remedy of Durande, 899. Alkaline 
Mineral -Waters, 194. (See Calculi, Bil- 
iary.) 

Condylomata : 
Calomel, 235, dusted over. Iodoform, 225, pow- 



644 



CLINICAL INDEX. 



der applied freely. Carbolic Acid, 524, a mild 
escharotic for simple cases. Chromic Acid, 
621, in paste to destroy; solution of bichromate 
of potassa a useful lotion. Nitric Acid, 94, a 
dilute solution as a wash. 

Conjunctivitis: 
Calomel, 239, dusted over membrane. Yellow 
Oxide of Mercury, 238, an ointment of, with 
vaseline, a most efficient remedy for granular 
lids. Tannin, 2T9, in powder dusted over 
membrane, an excellent application. Bismuth, 
135, also applied in powder directly. Copper, 
Sulphate, 252, a smooth crystal applied directly, 
an approved remedy. Silver Nitrate, 248, a 
Jong-standing, useful agent. Zinc Sulphate, 
263, a weak solution in rose-water, one of the 
best remedies for simple conjunctivitis. Cad- 
mium, 268, in solution, a substitute for copper 
and zinc. Fluid Extract of Ergot, 334, applied 
undiluted, is said to be very efficient. 

Constipation : 
Aliment, 147, highly important in habitual; bread 
of unbolted flour, corn-meal bread, fruits, and 
succulent vegetables. Cathartics, 558. Physi- 
ological laxatives ; Arsenic, 142, small doses of 
fowler's solution increase action. Nux Vomi- 
ca, 316, Physostigma, 474, Belladonna, 351, 
Tabaci Vinum, 479, Muscarine, 512, all act by 
either increasing secretion or muscular action, 
or both. Faradisation, 304, of intestines. 
Saline Mineral - Waters, 194, and the purga- 
tive Sulphurous Waters, 213. Enemata, 5S0. 

Convalescence : 
Koumiss, 41, a valuable reconstituent stimulant. 
Bitters, 150, the simple, especially calumba and 
gentian. Eucalyptus, 154, a tonic of special 
utility after malarial diseases. Hydrastis, 157, 
tonic, and useful substitute for quinia. Cuca, 
879, a tonic and stimulant of the nervous sys- 
tem ; also, Guarana, 3S2, belonging to the 
same class. Iron, 120, especially sirup of the 
iodide, the carbonate, sulphate and tincture of 
the chloride. Phospliates, 113, and Phosphites, 
113. Cod-liver Oil, 99, Pepsin, 84, and Pan- 
creatine, 84. Wine, 395. 

Convulsions : 
Anaesthetics, 409, in uraemic and puerperal con- 
vulsions. Bromides, 449, in epileptic and epi- 
leptiform. Chloral, 418, in puerperal, urasmic, 
and epileptiform. Morphia, 436, hypoder- 
matieally, in full doses, in ursemic convulsions. 
Verairum Viride, 503, in puerperal. 

Cough : 
Asafaetida, 371, in cough by habit, bronchorrhoea 
and chronic bronchitis ; also, under same con- 
ditions, ammoniac, bubeb, copaiba, turpentine, 
etc. Chloral, 419, in spasmodic cough, cough 
by habit, whooping-cough, etc. Gelsemium, 
465, useful to quiet a nervous element in cough. 
Lobelia, 483, a nauseating expectorant of great 
utility in dry cough, bronchitis, asthma, etc. 
Cerium, 269, in cough associated with, or reflex 
from, stomach derangement. Opium, 437, in 
some form, of chief utility as a means of quiet- 
ing cough. Prunus Virginiana, 152, anodyne 
and tonic expectorant. Hydrocyanic Acid, 



486, indicated in cough of irritation, habit, reflex' 
and stomachal. Grindelia, 506, especially use- 
ful in spasmodic cough, and as a stimulant ex- 
pectorant in chronic bronchitis. Lactucarium, 
442, sirup, an excellent vehicle for cough mixt- 
ures. Ipecacuanha, 557, especially the fluid 
extract, an excellent nauseating expectorant. 

Croup. (See Laryngismus Stridulus.) 
Alum, 271, emetic not depressing. Mercury 
Subsulphate, 235, the most efficient emetic in 
croup. Calomel, 235, by some supposed to be 
sedative and aplastic, allaying laryngeal spasm 
and preventing formation of membrane. Sul- 
phate of Copper, 241, Sulphate of Zinc, 260, 
as emetics inferior to turpeth mineral. Tartar 
Emetic, 266, causes dangerous depression in 
young children. Apomorphia, 552, effective 
but highly dangerous. Quinia, 174, in large 
doses highly useful. Lactic Acid, S6, a solvent 
of false membrane, applied in spray or directly. 
Carbolic Acid, 522, in spray. Lime - Water, 
1S9, steam by slaking lime. Ipecac, 555, as an 
emetic. 

Cysts : 
Iodine, 226, tincture or compound tincture in- 
jected is effective. Nitrate of Silver, 248, a 
solution injected into cysts to excite and adhe- 
sive inflammation. Galvano-puncture, 303, 
will usually permanently occlude. 

Cysts, Hydatid, of Liver or elsewhere : 
Iodine Injections, 226. Galvano-puncture, 308. 
Simple Acupuncture, 19G, and escape of some 
fluid, often suffices. 

Delirium Tremens : 
Alcohol, 389, of great utility when assimilation 
can not proceed without it. Bromides, 447, 
may cure the preliminary " horrors," and suc- 
ceed in mild cases of delirium tremens. Chlo- 
nal, 418, very effective, but dangerous in old 
topers and cases of weak heart. Chloroform, 
402, by the stomach, lessens delirium and pro- 
cures sleep. Arnica Tincture, 467, highly 
serviceable when there is much depression. 
Digitalis, 343, 344, tincture or infusion, espe- 
cially the former, in full doses in cases with 
cardiac depression, anaemia of brain, due to- low 
tension and lessened vis-a-tergo. Opium, 435, 
must be given cautiously, and the attempt to 
overwhelm the brain avoided. Quinia, 1 73, to 
restore digestion and support the powers of 
life. Cannabis Indica, 378, sometimes is re- 
markably quieting. Carbonate of Ammonia. 
203, required in condition of depression. Cap- 
sicum, 598, has hypnotic effects of great value 
in mild cases. 

Diabetes : 
Aliment, 38, all saccharine and starchy foods 
excluded. The Milk, Cure, 41, has succeeded 
remarkably in some cases ; Buttermilk, 42, may 
be better. Alkalies, 155, and Alkaline Min- 
eral- Waters, 195, of great value in the delirium 
of obese subjects. Arsenic, 144, in thin sub- 
jects, is often combined advantageously. Ar- 
seniate of soda, with phosphate of soda and the 
Phosphates, 114, which are also useful of them- 
selves. Lactic Acid, S7, has sometimes done 



CLINICAL INDEX. 



645 



good. Opium, 488, especially the alkaloid 
codeio, restrains the waste of sugar. Chloride 
<>t~ Gold, -ii, is a promising remedy. 
Diabetes Insipidus : 
Pry Did, 37. Ayot) 884, Is one of tho most 
efficient remedies. Pilocarpus, 471, has done 

good in some cases. Valerian, 374, restraius 
the How bnt does not cure. Muscarine. 512, 
has been used with apparent success. Auruni, 
■J41, the ohloride has boon useful in some cases. 
Iodide qf Potassium, 832, has cured cases of 
syphilitic origin. 
DlARRHCKA : 

Chalk, 168, in the diarrhoea of children, mistura 
cretie, with or without opium. Calomel, 288, 
in minute doses, or hydrarg. cum creta, when 
the stools are pasty and whitish. Bismuth, 
I'M. is useful, but large doses are necessary. 
Zinc Salts, 861, especially the Oxide, 261, 
which may be given with bismuth, or the sul- 
phate with morphia in the diarrhoea of adults. 
Sulphate of Copper, 251, is the most efficient 
of the mineral astringents in chronic diarrhtca; 
is usually combined with opium. Arsenic, 141, 
Fowler's solution, with tincture of opium when 
undigested food is passed soon after meal, and 
in chronic diarrhoea. Mineral Acids, 91, espe- 
cially sulphuric, in profuse watery stools, or 
Hope's mixture. Acetate of Lead, 256, one of 
the most generally useful astringents. Cam- 
phor, 3GS, with or without opium, for summer 
diarrhcea. Ergot, 881, has proved very success- 
ful in some epidemics. Tannic Acid, 27C, and 
vegetable astringents containing it, especially 
rubus, kino, catechu, are much employed in 
simple diarrhoea. Aliment, 33, 41, 47, milk 
cure, raw-meat pulp, but caution is necessary 
in respect to the latter, because of danger of 
tania. 
Diphtheria: 

Belladonna, 353, useful at outset to check exu- 
dation, and later to support weak heart. Car- 
bolic Acid, 523, locally, in solution and spray, 
and systematically. Chlorine, 515, aqua ehlo- 
rinii and chlorinated lime and soda topically to 
correct fetor and destroy germs. Lactic Acid, 
86, one of the best solvents. Sulphurous Acid, 
210, an antiseptic, in spray of dilute solution to 
fauces. Nitrate of Silver, 246, local application 
to fauces now but little used. Potassa Chlo- 
rate, 183, more largely used than any remedy, 
topically, and by the stomach. Iron, 123, tinc- 
ture of the chloride much employed, undiluted 
to the fauces, and by the stomach in full doses; 
also largely prescribed with potassa chlorate. 
Muriatic Acid, 89, was formerly applied to 
exudation. Salicylic Acid, 535, and the salicy- 
lates, the former also locally, to reduce tempera- 
ture and prevent systemic infection. Resorcin, 
541, acts similarly to carbolic and salicylic acids. 
Alcohol, 890, very much prescribed for support 
and to prevent diffusion of the poison. Recently 
Pilocarpus, 472, has been brought forward as 
- a remedy, but reports are conflicting. Benzoate 
of Sodium, 546, has been used with great suc- 
cess lately. 



Dropsy : 
Digitalis, 843, 314, one of the foremost remedies, 
especially in cardiac and renal dropsy, less so in 
dropsy of cavities. 8q u ill, 608, has effects very 
alike digitalis, and is prescribed under tho same 
conditions. Juniper, 599, I'ijisissewa, 601, 
Parsley, 6(14, Scoparius, 601, and other nrino- 
genitals having diuretic properties, of great 
value in cardiac dropsy; must bo used cau- 
tiously in renal dropsy. Copaiba, 595, espe- 
cially tho resin, has given good results in ascites. 
Potassa Salts, 185, especially bitartrate and 
acetate largely diluted, highly useful in renal 
dropsy. Iron, 124, especially tincture of the 
chloride, alone or in Basham's mixture, as a 
diuretic and to correct anosmia. Pilocarpus 
(Jaborandi), 471, very valuable in renal dropsy 
when secretion of urine is much reduced or 
suppressed. Hydrajoyue Cathartics, 576, 
especially indicated iu ascites. Saline Purga- 
tives, 568, in general dropsy. 

Dysentery, Acute : 
Aliment, 87, 41, 47, of first consequence. Saline 
Purgatives, 564, especially epsom salts in acute 
dysentery, with bloody discharges and high 
fever. Ipecacuanha, 556, a remedy of highest 
value in acute, epidemic, and puerperal ; must 
he administered in large doses; milk a good 
vehicle. Nitrate of Silver, 245, Sulphate of 
Copper, 251, Sulphate of Zinc, 261, are excel- 
lent astringents after the more acute symptoms. 
Acetate of Lead, 256, may be used at any pe- 
riod, but better after action of salines, in acute 
disease. Opium, 432, combined with some of 
the astringents, but given after the action of 
salines in the acute disease. Turpentine, 591 , 
in epidemic dysentery of low type. Ergot, 332, 
has been used with success in acute. 

Dysentery, Chronic: 
Aliment, 37, 41, 47, Grape Cure, 87, Arsenic, 
142, Fowler's solution with opium. Iron, 120, 
per nitrate, a powerful astringent. Tannic 
Acid, 277, with milk diet, and the vegetable 
astringents. Silver, copper, and zinc salts (as 
above), with opium. Nux Vomica, 317. Er- 
got, 332. Ipecac, 556, etc. 

Dysmenorrhea : 
Aconite, 499, and Pulsatilla, 505, for the con- 
gestive form especially succeeding to suppres- 
sion. Ergot, 384, under the same conditions 
as the two preceding; also, Cimicifuga, 847. 
Camphor, 369, Gelsemium, 466, and Apiol, 
604, are useful in the neuralgic form. Amyl 
Nitrite, 490, affords relief quickly. Chloro- 
form, 402, Atropia, 856, Chloral, 419, Canna- 
bis Indian, 378, Morphia, 437, all give relief in 
painful menstruation. Electricity, 307, galvan- 
ism during the interval is highly useful. Iron, 
125, in amernic cases. 

Dyspepsia : 
Diet, 87, 41, 47, the most important, especially 
the milk cure. Pepsin, 88, and Pancreatine, 
83, assist digestion in atonic dyspepsia. Min- 
eral Acids, 90, muriatic acid after meals, with 
or without pepsin, in atonic dyspepsia. In an 
excess of acid of stomach juice, the mineral acid 



G46 



CLINICAL INDEX. 



before meals. In excess of uric acid as well as 
of stomach acid, nitric acid before meals. Alka- 
lies, 1S3, to relieve excess of acid ; given before 
meals, alkalies favor the production of acid gas- 
tric juice; after meals, neutralize acid. Alka- 
line Mineral- Waters, 194, as well as alkalies, 
are highly useful in dyspepsia of obese subjects. 
Bitters, Simple, 150, especially gentian and 
calumba, stimulate digestion; may be given 
with acids or alkalies. Arsenic, 141, drop doses 
ofFowler's solution relieve irritative dyspep- 
sia. Silver, 244, oxide especially, is very use- 
ful. Nux Vomica, 316, is an excellent stom- 
achic tonic, and removes various nervous symp- 
toms. Hydrastis, 156, Eucalyptus, 154, Wild 
Cherry, 152, Hop, 442, are useful stomachic 
tonics. 
Ear-Ache : 

Opium,4Z8,in the form of morphia solution, which 
is usefully combined with atropia. 

ECLAMPSIA:. 

Transfusion, 16, has been successfully employed 
in uremic convulsions. Bloodletting, 619, 
when there is much cerebral congestion. Mor- 
phia, 436, hypodermatically in uraemic. Chlo- 
roform, 409, by inhalation. Chloral, 419. Bro- 
mide of Potassium, 449. 

Ecthyma : 
Cod-liver Oil, 101, both internally and locally. 
Quinia, 1T4, usually effects a cure, but must be 
given in full doses. 

Eczema : 

Carbolic Acid, 524, internally and externally. 
Salicylic Acid, 538, applied locally. Boracic 
Acid, 543, one of the most efficient remedies, 
locally. Lead, 25T, 25S, liquor plumbi subace- 
tatis with glycerine, a good application when 
there is abundant secretion. Bismuth,, 134, in 
powder freely to the eruption. Tannin, 279, 
in powder dusted over, or as glycerite of tan- 
nin. Copper Sulphate, 252, Zinc Sulp7iate, 
262, Silver Nitrate, 247, are useful astringent 
applications. Mercury, 238, the brown citrine 
ointment to eczema of eyelids. Belladonna, 
355, or atropia, internally, is beneficial in the 
acute cases. Arsenic, 144, is curative in 
chronic cases. Electricity, SOT, by central 
galvanization has done great good in chronic 
cases. 

Emphysema : 
Compressed Air, 77, affords much relief, some- 
times permanent. Oxygen, 514, for the parox- 
ysms of difficult breathing. Grindelia, 506, 
gives great relief to the oppression. Arsenic, 
142, long continued, improves the nutrition of 
the lungs. Cod-liver Oil, 99, improves the 
condition ; Hypophosphites, 114, also. Strych- 
nia, 319,- is a valuable respiratory stimulant. 

Empyema: 
Iodine, 225, a solution of iodine and iodide of po- 
tassium to wash out the cavity and prevent re- 
formation of pus. Carbolic Acid, 524, and 
carbolate of iodine, 524, to correct fetor. 

Endocarditis : 
Quinia, 167, to check inflammation. Chloral, 
41S, Salicylic Acid, 536, is useful in the rheu- 



matic form of the disease. Morphia, 433, as a 
remedy in serious inflammations. 

Endometritis : 

Carbolic Acid, 525, undiluted on cotton- wrapped 
probe. Iodo-tannin, 226, and iodoform and 
taDnin locally. Chromic Acid, 621, applied in 
solution to interior of cavity. Nitric Acid 
(fuming), 95, highly efficient. 

Enteralgia : 
Milk Cure, 42, stops the troubles of digestion 
which give rise to the pain. Arsenic, 141, is 
remarkably beneficial in the more strictly neu- 
ralgic cases. Belladonna, 351, is useful as an 
anodyne, atropia especially. Prussic Acid, 
436, official solution, gives relief promptly, or 
fails entirely. Galvanisation, 306, centric, per- 
sistently applied, is curative sometimes. 

Enteritis. (See Diarrhoea, Dysentery ) 
Diet, 39, 41, 44, must be regulated, an essentia] 
point in treatment. Arsenic, 142, with opium, 
usually highly effective as a remedy. Copper 
Sulphate, 251, Lead, Acetate, 256, and the 
other mineral astringents, with opium, are cu- 
rative. 

Epilepsy : 
Amyl Nitrite, 490, inhaled when aura is felt may 
prevent seizure ; Nitro-glycerine, 493, also, if 
there be more time. Bromide of Potassium. 
443, 449, is the most useful remedy, but is 
adapted to the cases occurring in the daytime, 
to the grand mal, and to reflex epilepsy, and 
to the condition of cerebral hyper£emia rather 
than anaemia. Chloral, 419, is the most suit- 
able remedy for the nocturnal variety. Can- 
nabis Indica, 378, Atropia, 354, Strychnia, 
318, Picrotoxine, 324, are suitable for piettit 
mal, for nocturnal variety, for cases character- 
ized by anaemia and depression, and must be 
faithfully persisted in for a long time. The last- 
named seems most promising. Silver Ni- 
trate, 245, formerly much prescribed, and not 
without utility, but the danger of straining is 
great. Salts of Copper, 249, Zinc Oxide, 261, 
so called, nervine tonics have been beneficial, 
but are not curative. Iron, 123, especially the 
bromide, with potassium bromide to prevent 
the ana?mia and depression caused by the lat- 
ter. 

Epistaxis : 
Ergot, 333. Barium Cldoride, 206, Digitalis, 340, 
Ipecacuanha, 557, restrain haemorrhage by act- 
ing on the vessels. Turpentine, 591, in oozing 
from relaxation. Locally Tannin, 279, iu solu- 
tion injected. Iron, 120. subsulphate in spray 
or solution injected. Alum, 271, powder insuf- 
flated, or solution injected. Transfusion, 13, 
when a fatal result is threatened from loss of 
blood. 

Epithelioma : 

Coptis, 150, iDfusion or decoction locally, espe- 
cially in epithelioma of the tongue. Potassa 
Chlorat, 191, recently ascertained to be very 
effectual applied in powder. Zinc Chloride, 
and Sulphate dried, 262. useful escharotics. 
Carbolic Acid, 524, injected beneath tumor. 
Salicylic Acid, 539, and Boracic Acid, 548. 



CLINICAL INDEX. 



647 



Erysipelas : 
Aconite, 49s, in the Idiopathic variety, when 
therein much fever. Btttadonna, 258, a very 
beneficial remedy, combined with aconite when 
there is sthenic reaction. Quinia, i(i>, in mil 
doses in the more severe cases, to sustain the 
powers of life and prevent cerebral embolism, 
Salicylic Acid and Salicylates, 685, Bwuwate 
of Sodium, 546, and Resorcin, 541, to prevent 
systemic infection in traumatic variety ''<(/■- 
inmate of Ammonia, 203, when cardiac depres- 
sion exists. Iron, 128, especially tincture of 
the chloride in large doses. Locally Argenti 
Nitras, -IT, according to Iligginbotham's 
method, OarooMe Acid, 523, and the antiseptics 
generally to the inflamed area. Oil inunctions 
are very grateful in simple erysipelas, 98. 

Erythema : 
Quinia, 174, !s very effective In erythema nodo- 
sum; Belladonna in simple E. Zinc, 268, 
Alum, 272, and Lead, 258, are suitable local ap- 
plications, as lotions. Bismuth dusted over 
the surface allays irritation. When the disease 
is reflex from gastro-intestinal disorder, Nitric, 
90, and Muriatic Acids, 90, are beneficial. 

Exophthalmic Goitre : 
Iron, 122, and Chalybeate Waters, 132, for the 
anaemia. Digitalis, 341, Barium, 206, Ergot, 
825, and in some cases Belladonna, 351, raise 
the arterial tension and slow the heart. Gal- 
vanism, 306, in uncomplicated cases, is decid- 
edly curative. 

Fayts : 
Cod-liver Oil, 101, locally, and in case of debili- 
ty, by the stomach. Carbolic Acid, 524, an 
efficient parasiticide. Myrtol, 547, llesorcin, 
542, Salicylic Acid, 53S, and Boracic Acid, 
548, are efficient local applications. 

Felon : 
Nitrate of Silver, 246, a strong solution in nitric 
ether applied over the part may abort the affec- 
tion, if at the beginning. 

Feet, Fetor of: 
Potassa, Permanganate, 129, in solution, will 
remove fetor temporarily. Bicarbonate of 
Soda, 190, a saturated solution, is serviceable. 
Salicylic Acid, 53S, in powder freely dusted 
'over the feet and stockings, is very effective. 

Fever : 
Aconite, 497, highly useful in simple inflamma- 
tion, and in the eruptive fevers. Aliment, 
41, 44, 45, must be regulated. Alcohol, 390, 
S9G, docs good when the temperature declines, 
the pulse falls, the skin perspires, and the 
tongue grows moist. Baths, Cold, 60, 62, cer- 
tain method of reducing body-heat, and es- 
pecially valuable in typhoid and pneumonia. 
Digitalis, 342, is indicated in inflammatory fe- 
ver and in the eruptive fevers during the first 
stage, and as an aid to quinia when employed 
as an antipyretic. Quinia, 169, occupies the 
first position as an antipyretic, and is more 
generally applicable than any other. Chloral, 
418, reduces fever, and is highly useful when 
high febrile excitement coincides with delirium 
and wakefulness. Salicylic Acid, 535, llesor- 



cin, 541, Benzoate of Sodium, 545, arc anti- 
pyretic and antiseptic. Culminl, 286, and com- 
pound solution of /inline, 228, the former ad- 
ministered during the first week, and the latter 

during the whole oonrse of typhoid fever, affect 
the oourse and duration favorably; "the spe 

cific treatment" of the Germans. Carbolic 
Acid , 628, and Carbo/ate of Iodine, 222, have 
good effects in typhoid. Turpentine, 591, in 
typhoid, puerperal, and yellow fever, when 
there is much vaso-motor depression, luemor- 
rhage, etc. 
Fissure oe the Anus : 
Hydrastis, 157, the fluid extract applied undi- 
luted. Iodoform, 225, dusted well over the 
fissure, and lodo-tannin, 220, applied in the 
same way. 
Fissure of Nipples: 
Iron, 126, liquor ferri subsulph., and glycerine ap- 
plied with a brush. Tannin, 279, in powder 
or the glycerite. Tincture of Benzoin, 544. 
with glycerine. Brandy, 391, with or without 
glycerine. Collodion, 623, or flexile collodion, 
applied to close fissure. Nitrate of Lead, 258, 
with simple ointment or glycerine, is the most 
efficient application. 

Flatulence : 
Calumba, 151, with nromatics. Camphor, 367, 
will often give prompt relief. Chhrqfori/1,401, 
especially the spirit. Asafoetida, 871, Vale- 
rian, SIS, and Spirit of Ether, compound, are 
adapted to nervous and hypochondriacal cases 
Turpentine, 590, is indicated in the flatulence 
of fevers, peritonitis, etc. Nux Vomica, 816. 
Belladonna, 851, Physostigma, 474, and prob- 
ably Muscarine, 512, give relief to those cases 
of flatulence dependent on paresis of the mus- 
cular layer of the bowel. Diet is of the highest 
importance, in cases arising from intestinal in- 
digestion. 

Freckles: 
Alkalies, 190, in form of a lotion composed of 
potassa carbonate and chloride of soda. Bibo- 
rate of Soda, 190, a saturated solution, is a safe 
and often successful lotion. 

Gall-Stones. (See Calculi, Biliaky.) 

Gangrene : 
Bromine, 517, one of the best eseharotics in hos- 
pital gangrene to arrest morbid action. Chro- 
mic Acid, 621, is a highly efficient caustic, and 
penetrates deeply with little pain, comparative- 
ly. Chloride of Zinc, 262, powerful, but pain- 
ful. Potassa Fusa. 191, an active escharotic. 
Nitric Acid, 86, 91, next to bromine, is the 
most useful caustic to arrest tho destruction of 
parts, external, by gangrene. Salicylic Acid, 
589, Eesorcin, 542, Myrtol, 548, and Carbolic 
Acid, 522, are useful to destroy fetor, and 
change the character of the morbid action. 
Turpentine, 591, internally and by vapor in- 
haled, Eucalyptol, 155. Camphor, 869, are 
highly useful in gangrene of the lungs to pre- 
vent extension and to destroy fetor. 

Gastralgia : 
Aquapuncture, 617, gives great relief. Alum, 
271, affords relief in gastralgia with pyrosis. Ar- 



648 



CLINICAL INDEX. 



seme, 141, drop-doses of Fowler's solution are 
remarkably beneficial. Ether, 399, some drops of 
sulphuric ether or Hoffmann's anodyne. Atro- 
pia, 351, by the stomach or subcutaneously. 
Bismuth,. 134, acts well, but is more efficient if 
given with aromatic powder and a little mor- 
phia. Chloroform, 401, a few drops, acts 
promptly. Oxides of Zinc, 260, Manganese, 
128, and Silver, 244, have curative effects, but 
do not act quickly. Hydrocyanic Acid, 4S6, 
and especially Nitro-glycerine, 493, allay the 
pain speedily. In cases' having a distinct peri- 
odicity, Quinia and Salicylic Acid, 534, have 
acted well, and liesorcin, 541, will probably be 
found beneficial. Nux Vomica, 316, may re- 
move the morbid state on which the pain de- 
pends. Morphia, 431, subcutaneously, alone 
or combined with atropia, stops the pain at 
once. Galvanism, 306, the pneumogastric and 
sympathetic acted on, has been successful. 
• Diet, 41, 4T, is of the utmost consequence. 

Gastric Catarrh : 
Aliment, 41, 47, especially the milk-cure. Ar- 
senic, 141, is the most important remedy; next 
are Oxides of Silver, 244, Manganese, 128, and 
Zinc, 260, Bismuth, 134, Alum, 270, and Ace- 
tate of Lead, 256. The Bitters, 14S, especially 
Calumba, 150, Nux- Vomica Tincture, 316, 
Cinchona Infusion or Quinia, 166, Eucalyp- 
tus, 154, and Hydrastis, 156, are beneficial, if 
not continued too long. 

Gastric Ulcer : 
Milk-Cure, 41. Rectal Alimentation, 51. Nu- 
trient Enemeta, 50. Acetate of Lead, 256, 
sedative and arrests haemorrhage. Bismuth, 
134, allays pain and arrests vomiting. Arsenic, 
141; Fowler's solution in drop-doses also less- 
ens pain and vomiting remarkably. Silver Ox- 
ide and Nitrate, 214, promote cicatrization and 
relieve pain. Morphia and Atropia, 431, 351, 
arrest pain and vomiting, even in very minute 
quantity. 

Gastritis, Acute : 
Ice, 63, Hydrocyanic Acid, 4S6, Morphia, 431, 
subcutaneously or endermically. Rectal Ali- 
mentation, 51. 

Gastritis, Chronic (The same as for Gastric 
Catarrh.) 

Glands, Lymphatic. A ffections op : 

Carbolic Acid, 524, properly diluted, injected 
into the substance of glands. Iodides of Iron 
and Manganese, 221, 225, internally, and tinct- 
ure of- iodine injected into the substance of 
glands. Sulphides, 212, are said to mature or 
abort suppuration in glands. Chloride of Cal- 
cium, 1S9, is highly useful in strumous in- 
flammation and suppuration. Pilocarpus, 471, 
has a curative action in acute affections of paro- 
tid and submaxillary glands. Conium, 455, 
locally and systemically, has long been regarded 
as discutient. Mercury, 233, especially bichlo- 
ride, in acute inflammatory diseases of tonsils, 
parotid and submaxillary glands. Iodide of 
Lead, 25S, as an ointment externally. Oint- 
ment of the Red Iodide of Mercury, 239, has 
remarkable effects in goitre, enlarged spleen, etc. 



Gleet : 
Iron, 126, tinct. ferri chloridi, in anaemic subjects. 
Turpentine, 592, is beneficial when the local 
condition is one of relaxation. Juniper, 599, 
Cantharides Tinct., 609, are useful under 
same circumstances. Blisters, 615, to the peri- 
na;um are very beneficial. 

Goitre : 
Iodine, 221, both internally and locally, effective 
in the case of simple hypertrophy. Ointment 
of the Red Iodide of Mercury, 239, exception- 
ally useful in same state. Injections of Tinct- 
ure of Iodine, 225, very effective in cystic de- 
generation. Electrolysis, 303, has succeeded 
in simple hypertrophy and cystic state of gland. 

Gonorrhoea : 
Internal Remedies. — Copaiba, 594, Cubeba, 597, 
Buchu, 600, and other urino-genital remedies, 
more useful after acute symptoms. Colchicum, 
2S3, Saline Laxatives, 562, Aconite, 493, and 
Veratrum Viride, 503, during the first acute 
symptoms. Turpentine, 592, and Cantharides 
Tincture, 609, for the chronic stage. 
Injections. — Bismuth, 135, with or without Ft. 
Ex. of Hydrastis, 157, is one of the best. Zinc 
Sulphate, 263, a very- weak solution, often re- 
peated, can be used at once, or chloride or sul- 
phate of zinc and Acetate of Lead, 253, in 
combination. After the acute symptoms, 
stronger solutions of above and Nitrate of Sil- 
ver, 24S, Sulphate of Copper, 252, Subsulphate 
of Iron, 126, Cadmium Sulphate, 263, Alum< 
271, and Tannin, 2S0. 

Gout: 
Aliment, 50, of first importance. Alkalies, 1P0, 
and Alkaline Mineral Waters, 194, 195, espe- 
cially potash and lithium salts. Manganese 
Salts, 127, very serviceable in chronic gouty 
affections. Salicylic Acid, 538, and salicylates 
very effective in the acute form. Guaiac, 286, 
after acute symptoms. Colchicum, 282, espe- 
cially colchicia, the most celebrated remedy for 
the paroxysms. Arnica, 467. Arsenic, 133. 
Sulphurous Waters, 216. Sulphur-Baths, 216. 

Gums, Affections of : 
Alum, 271, for spongy and bleeding. Tannin, 
279, especially Glycerite, 279, for same condi- 
tion. Carbolic Acid, 524, and Carbolate of 
Iodine, 524, when fetor is present. Benzoin 
Tincture, 544, with or without glycerine. Re- 
sorcin, 541. 

H/Ematemesis : 
Alum, 270, especially in passive. Acetate of 
Lead, 256, maybe used in all conditions. Iron, 
120, as Monsel's solution, one of the most effec- 
tive applications. Tannin, 276, and the vege- 
table astringents, especially Hammamelis, 276, 
Rhatany, 274, and Logwood, 274, Turpentine, 
591, in weak and relaxed state of vessels. Er- 
gotin, 332, subcutaneously. 

HEMATURIA : 

Ergot, 333, by the stomach or subcutaneously ; 
may be combined with rhatany, ipecacuanha, or 
other astringents. Gallic Acid. 277, 27S, one 
of the most useful remedies. Rhatany, 277, 
owes its utility to the presence of tannic and 



CLIXICAL IXDEX. 



G49 






gallic acids. Quinia, 178, Is highly cffectivo in 
the Intermittent trouble; Turpentine, 591, iu 
the bnmorrhaglo state or passive. 

HEMOPTYSIS: 

Ergot, 833, with ipecac ami a littlo opium by the 
stomach : ergotin subeutaneously. Gallic Acid 
and ergot, 277, by the stomach. Ipecacuanha, 
557. Digitalis, 840. Tine/, of ]',rat. Vivid, 
502. Barium Chloride, 206. Iron, 120, sub- 
sulphato solution iu spray, a highly cffectivo 
application. Acetate of Lead, 257, with opium, 
frequently prescribed, but not so effective as 
the previously named. 

HEMORRHAGE AND HEMORRHAGIC DlATITESIS : 

Arterial Sedatives. — Digitalis, 810, Yerat. Vi- 
vid,'. 60S, Aconite, 497, Acetate of Lead, 257, 
Barium Chloride, 206, Venesection, 620, Ipe- 
cac, 557, and Ergot, 332, 838, act by slowing 
the heart and diminishing the caliber of the 
vessels, and are therefore adapted to active 
hreiuorrhage. Turpentine, 591, Ammonia, 
202, by stomach and by intravenous injection, 
and Alcohol, 891, 396, relieve, by increasing the 
contractile energy of the vessels, and are there- 
fore indicated in passive hretoorrhage. To these 
must be added Transfusion, 16, when death is 
imminent from simply loss of blood. Astrin- 
gents are employed locally and systemically, 
and include Alum, 272, Acetate of Lead, 257, 
Iron, Subsulphate and Chloride, 120. 121, Sul- 
phuric Acid, 98, Tannin, 277, Gallic Acid, 
277, and the Vegetable Astringents, 278, con- 
taining Tannin, 27S, Alcolwl, 891, 396, Alum, 
271. 

Hemorrhage, Cerebral : 

Venesection or Leeches, 620, when the blood- 
pressure is high and haemorrhage threatened or 
proceeding. Purgatives, 566, under the same 
circumstances. Ergotin, 833, Barium Chlo- 
ride, 200, and arterial sedatives, when collateral 
hypera?mia comes on. 

Hemorrhage, Intestinal : 

Tannic Acid, 277, and vegetable astringents. 
Acetate of Lead, 257. Sulphuric Acid, dilute, 
91. Iron, pernitrato, 121. Turpentine, 591. | 
Opium, 433, to quiet intestinal movements. 
Ice, 65, to abdomen. Ergotin, 333, hypoder- 
matical'.y. 

Hemorrhage, Uterine: 
Ergot, 333, fluid extract in full doses. Ipecac, 
557, carried to nausea merely, is highly effective. 
Digitalis, 841, Nux Vomica, 817, Barium 
Chloride, 206, Sulphuric Acid, dilute, 91, 
6mall doses frequently, and Epsom Salts, 564. 
Cold, 65. Ilot Water, 66. Iron, 126; Mon- 
sel's solution, diluted, injected. 

Hemorrhoids: 
Aloes, 571, in recent haemorrhoids, as after deliv- 
ery, highly useful. Ergot, 332, in dilated ha?- 
morrhoidal veins without new tissue, by the 
stomach and topically. Alkaline, 194, Sulphu- 
rous, 213, and purgative Chalybeate Waters, 
132. Saline Purgatives, 564, notably Epsom 
salts, in bleeding piles. Senna, 567, the con- 
fection especially, Sulphur, 559, and Cream of 
Tartar, 564, to render movements soft and 



easy. The Grape-Cure, 37. Alum, 271. Iron, 
ISO; Monscl's solution to arrest bleeding 
Leec/ies, 620, to inflamed piles. Nitric Acid, 
94, to the mulberry, bleeding pile. Ung. Gallm, 
380, Ointment for hemorrhoids. 

Hay-Fever : 
Arsenic, 142, internally and in cigarettes. Atro- 
pia, 862, when secretion Is profuse. Carbolic 
Acid, 522, by inhalation. Quinia, HlO, 174, is 
useful at onset in spray, locally, and later as a 
tonic. Iodides, 220, carried to iodism, afford 
great relief; may be combined with arsenic. 
Grindelia, 506, for the asthmatic symptoms. 
Muscaria, 512, will probably prove useful in 
the asthmatic stage, if membrane is dry. Mor- 
phia, 437, is probably beneficial at any stage, 
but great danger of morphia-habit. 

Headache : 
Ammonia, 202, for nervous headache; especially 
aromatic spirits. Arsenic, 148, for cerebral 
congestion and homicrania. Bromides, 44S, 
for true migraine. Digitaline, 343, in con- 
gestive hemicrania, from venous hyperemia. 
Ergot, 833, in the headache of miliary aneu- 
risms and in arterial hyperemia. Galvanism, 
805, applications to cervical sympathetic during 
intervals, persistently, and mild transverse ap- 
plications during seizure. Nitrate of Amyl, 
490, by inhalation in cases characterized by 
vaso-motor spasm (pallor of face). Also Nitro- 
glycerine, 493, internally under same condi- 
tions. Potassium Cyanide, 4S#, a solution 
applied on compress to painful region. Phos- 
phate of Soda, 113, in headache duo to "bil- 
iousness." Picroloxine, 325, in neuralgic head- 
ache; also Strychnia, 821. 

Heart, Diseases of : 
Aconite, 497, Veratrum Viride, 502, and Bro- 
mides, 440, for over-action and simple hyper- 
trophy. Digitalis, 341, in rapid action with 
low tension and valvular lesions. Cimicifuga, 
847, under the same conditions. Ergot, 832, is 
useful in dilated heart. Amyl Nitrite, 491, iu 
angina pectoris ; also Nitro-glycerine, 493. 
Iron, 124, remarkably beneficial in the irritable 
heart of ausemia. Morphia, 433, hypodermati- 
cally in dilated heart and general dropsy, there- 
from. Quinia, 167, in peri- and endo-carditis 
and cardiac weakness. Ammonia, 202, inhaled, 
intravenous, and by the stomach in sudden 
failure. Alropia, 851, a prompt cardiac ex- 
citant. 

Hemiplegia : 
Galvanism, 802, cautiously applied to the brain ; 
faradism to the muscles, if they waste or de- 
generate. Strychnia, 313, 320, hypodermati- 
cally into the paralyzed muscles, after local 
troubles have ceased. Massage, 79. 

Hepatic Diseases : 
Aconite, 498, in acute inflammation. Alkaline 
Mineral Waters, 197 ; also Sulphurous, SIS, In 
portal congestion. Colchicum, 2S3, is an active 
remedy in congestion of the liver. Nitro-Mu- 
riatic Acid, 91, and the acid-bath, are useful in 
torpor of liver. The resin-bearing purgatives, 
Rhubarb, 563, Podophyllum, 574, Iris, 576, 



650 



CLINICAL INDEX. 



and Euonymus, 576, are active cholagogues. 
Ipecacuanha, 556, has decided effects in stim- 
ulating the How of bile. Chloride of Ammo- 
nium, 202, and Iodide of Ammonium, 219, 
are useful in catarrh of the bile-ducts ; also 
Phosphate of Sodium, 118, Chloride of Gold, 
240. Mercurials, 233, of doubtful propriety. 
Phosphorus, 109, prevents the formation or 
checks the growth of connective tissue (sclerosis). 

Heepes : 
Acetate of Copper, 252, as an ointment; Calo- 
mel, 23S, also as an ointment, and Zinc Oint- 
ment, 2G3, are curative. Belladonna or Atro- 
pia, 855, internally, is useful. Myrtol, 547. 
Gahdnism, 307, in cases having a neurotic 
origin, as H. Zoster. 

Hoarseness : 
Nitric Acid, 92, is highly effective in hoarseness 
of singers and reflex from stomach trouble?. 
Atropia, 352, affords prompt relief usually in 
hysterical aphonia. 

Hydrocele : 
Carbolic Acid, 524, injected into the sac after 
the withdrawal of the fluid. Iodine Tincture, 
226, injected in the same way. Nitrate of Sit- 
ter, 24S, a sufficiently strong solution thrown 
into the sac after fluid is removed. Gahano- 
puncture, 30S, sometimes succeeds. 

Htdhopdobia: 
Amyl Nitrite, 491, by inhalation, and Nitro- 
glycerine, 494, by the stomach, should be faith- 
fully tried. Curara, 4G1, has apparently suc- 
ceeded. Morphia, 436, Ether and Chloroform, 
409, by inhalation, are palliative. 

Hydrotiiorax : 
Iodine Injections, 225, to prevent reaccumula- 
tion of fluid Pilocarpus, 471, to cause ab- 
sorption. Resin of Copaiba, 595, as a diuretic. 
Dry diet, 37. , „ 

Hypochondria : 
Arsenic, 143, has good effects in the hypochon- 
dria of the aged. Colchicum, 2S3, with colo- 
eynth, to deplete the portal circulation. Caffein, 
SS2, is a serviceable cerebral stimulant in these 
cases. Asafuelida, 371, is particularly indicated, 
and has great value in cases characterized by 
much flatulence. Opium, 371, small doses of the 
tincture, is a remedy of the first importance. 
Chloride of Gold, 241, gives excellent results 
in the hypochondria of the aged. 

Hysteria : 
Ammonia, 202, the aromatic spirits, for the hys- 
terical seizure. Asafcelida, 371, Valerian, 
373, Camphor, 363, Eucalyptus, 154, Ether, 
400, are useful remedies to relieve the vapors 
and accompanying symptoms. Phosphates, 
113, Iron, 123, Cuca, 3S0, Cod-liver Oil, 100, 
Massage, Rest, and Faradism, 80, are the 
remedies to relieve the abnormal mobility of 
the nervous system. 

Impetigo ; 
Glycerite of Tannin, 279, an excellent applica- 
tion. Acetate of Lead, 25S, in solution. Zinc 
Oxide, 263, dusted over or ointment applied. 
Quinia, 174, usually improves. The Mineral 
Acids, 93, in intestinal indigestion. 



Impotence : 
Phosphorus, 109, or Phosphide of Zinc, 109, are 
efficient stimulants. Cannabis Indica, 378, 
also stimulates the function. Nux Vomica, 
317, Sanguinaria, 291, Serpentaria, 375, also 
increase sexual activity, but differ in degree. 
Ergolin, 334, subcutaneously about the dorsal 
vein of the penis, or Fluid Extract of Ergot, 
834, by the stomach, increase the vigor of the 
erections. Arseniate of Iron, 145, acts as a 
tonic to the organs. Chloride of Gold, 241, 
has also slowjy acting aphrodisiac effects. 

Incontinence, Nocturnal : 
Belladonna or Atropia, 354, carried to the point 
of inducing some physiological action. Ergot, 
834, in cases due to paresis of the muscular lay- 
er (?). Iron, 126, sirup of the iodide, in weak, 
aniemic subjects. 

Indigestion : 
Aliment, 46, 47, 53. In stomach indigestion, give 
foods digested chiefly in intestine, and, in intes- 
tinal indigestion, food digested chiefly in stom- 
ach. Milk-cure, 41. Pepsin, SI, Pancreatine, 
82, Ingluvin, 61 — digestive ferments. Mineral 
Acids, 90, and Lactic Acid, S6, in atonic dys- 
pepsia and indigestion. Alkalies, 183, and 
Alkaline Mineral Waters, 194, for the indi- 
gestion of the obese, gouty, and rheumatic. 
Sulphurous Acid, 210, for indigestion with 
pasty vomiting, sarcina, etc. Bismuth, 133 
for painful indigestion and nausea ; also Hydro- 
cyanic Acid, 486. Strychnia, 316, or tinct. 
nucis vom., to stimulate organs; also Picro- 
toxine, 324. Aloes, 570, in indigestion with 
torpor of large intestine, and pasty motions. 
Alcohol, 3S9, an excellent stomachic tonic in 
moderate quantity for the indigestion of the 
old. 

Inflammation : 
Aliment, 46. Water, 59, the methods of hydro- 
therapy, to reduce heat. Alcohol, 396, in con- 
dition of systemic and cardiac depression, as an 
antipyretic, etc. Leeches, 619, very useful in cer- 
tain local inflammations superficially situated, 
the systemic condition being sthenic. Aconite, 
497, useful in inflammation of respiratory organs 
and parencbj'matous inflammations in general. 
Veratrum Viride, 502, Gelsemium, 465, Ar- 
nica, 467, and especially Digitalis, 842, are 
valuable as arterial sedatives to diminish blood- 
supply to inflamed area, and cease to be benefi- 
cial when exudations begin. Belladonna, 352, 
in some catarrhal inflammations is highly use- 
ful. Alkalies, 184, especially the potash salts, 
and ammonia, are very valuable in the exuda- 
tion 6tage. Saline Cathartics, 563, to lower 
the blood-pressure and to cause excretion of 
products of waste. To the remedies acting on 
the circulation may be added Barium Chloride, 
206, and Muscaria, 512, and under some cir- 
cumstances Ergot, 334, Quinia, 167, in full 
quantity, especially when combined with opium, 
may abort an incipient inflammation. Opium, 
433, is the most important remedy in serous 
inflammation. Tartar Emetic, 267, affords 
undoubted good results in some forms, notably 



CLINICAL INDEX. 



651 



luacuto bronchitis. Pilocarpus, 4U, has very 

satisfactory results in exudation In the eye, 
pleura, eto 
Insolation. (Stjnstboke.) 
Cold Hath, 68, or douche or wet nook, for tho 
Btate of high fever. Morphia, 486, hypoder- 
matic-ally. Turpentine Enema, BOO, oh a de- 
rivative. Brandy, 889, end Ammonia, 202, for 
heat-exhaustion. 

Insomnia : 

Alcohol, 8:I0, in tho condition of cerebral ainvinia, 
or in quantity to induce narcosis. Chloral, 
■lis ihe moatdireot and generally useful hyp- 
notic. Belladonna, 804, in some morbid states 
With great restlessness and delirium ; but Ilyox- 
cyamia, 368, and Dubaisia, 3G5, in sufficient 
quantity, are more frequently successful, cspe- 
■ cially in the insomnia of mania, puerperal ma- 
nia, etc. Bromide of Potassium, 447, a direct 
hypnotic, but the action is easily prevented. 
Morphia, 485, is generally the best sleep-pro- 
ducer in cases of pain, in some kinds of mania, 
and in melancholia. IIttniulus,i42, a hoppil- 
low, has induced sleep ; lupuliue is more effec- 
tive. I'hosphorus, 109, under some circum- 
stances acts well. Galvanisation, 302, of cer- 
vical sympathetic, causes sleep when circum- 
stances are favorable. Water, 64, a tepid or 
warm bath at bed-hour, sometimes succeeds. 

Intermittent Fever : 

Cinchona, 170. Quinia is prophylactic; rightly 
used prevents malarial infection, and in proper 
quantity arrests the paroxysms. In severe 
oases, combination with morphia is very effec- 
tive. An attack impending may be arrested by 
Amyl Nitrite, 490, or Nitro-glycerine, 493, as 
far as the chill ; but Pilocarpine, 471, hypo- 
dermatically. may bring on the sweating stage, 
thus preventing chill and- fever. Chloroform, 
402, by inhalation, or by the stomach in a full 
dose, may pre7cut a chill. Salicin, 52S, Sali- 
cylic Acid, 535, and Resorcin, 541, especially 
the last named, have decided antiperiodic quali- 
ties only inferior to quinia. Carbolic Acid, 
523, hypodermatically, seems to be quite effec- 
tive. Apiol, 604, also has very decided anti- 
periodic qualities. Salicylate of Cinchonidia, 
159, a recently introduced antiperiodic, is high- 
ly promising. Other substitutes for quinia are 
Nitric Acid, 92, which acts quite well in mild 
cases: Ilydrastia, 157, which is very efficient, 
and probably next to quinia, if given in large 
doses ; Eucalyptus, 154, more adapted to 
chronic malarial poisoning, and for convales- 
cence after attacks of fever; Oleoresin of Cap- 
sicum, 597, and Nux Vomica, S20, adjuncts to 
other and more powerful remedies. 

Intertrigo : 
Bismuth, 135, dusted over the surface. Zinc 
Ointment, idS, Glyceritc of Tannin, 279. 

Intestinal Catarrh : 
Ammonium Chloride, 202. Bismuth, 134, is 
one of tho best remedies. Calomel, 233, in 
minute doses frequently. Nitrate of Silver, 
244, Sulphate of Copper, 251, Acetate of Lead, 
256, Sulphate and Oxide of Zinc, 261, are ex- 



ci Unit remedies, valuable Is tho order named. 
The vegetable tunic astringents, Eucalyptus, 

104, Hydrastis, 157, and thoso containing Tan- 
nic Add, 2T6, are also useful 

Intestinal 1'akasites : 

Ciloiml, 234, for tho round worm; also Hydro- 
cyanic Acid, 486. Carbolic Acid, 621, but 
eflpeclollj Glycerine, 622, fox intestinal trichi- 
na. Remedies against the round worm, San- 
toninc, SpigeHa, etc., 5S3. 

Intussusception : 
Ef)\ rvesoent Enemata, 5S2 ; also Irrigation, 582, 
acting mechanically. Tobacco Enema, 479, to 
relax spasm. Morphia, 431, hypodermatically 
of first importance. Belladonna, 351. 

Iritis : 
Atropia, 855, to prevent adhesions, and check in- 
flammation by emptying vessels of iris. Ese- 
rine, 477, now much employed to break up ad- 
hesions and diminish intra-ocular tension. Pi- 
locarpine, 471, to cause absorption of exuda- 
tions and effusions. Mercury, 284, of gnat 
importance, as most cases are specific. Ihthoi- 
sia, 365, is much employed as a substitute for 
atropia. 

Javndice : 
Aliment, 41, 47, especially the skim-milk euro, 
avoidance of fats, etc. Alkalies, 1S3, and the 
Alkaline Mineral Waters, 194. Phosphate of 
Soda, 113, tho most useful remedy in catarrh of 
bile-ducts, and in incipient sclerosis. Chloridt 
of Ammonium, 202, and the Iodide, 219, are 
beneficial under tho same circumstances. Man- 
ganese, 129, has unquestionable cholagoguo 
effects, and stimulates the discharge of bile ; is 
adapted to tho catarrhal form, and to the jaun- 
dice of gouty subjects. The resin-bearing ca- 
thartics, Rhubarb, Aloes, Podophyllum, Iris, 
and Euonymin, 576, promote tho excretion of 
bile. Nitro-Muriatic Acid, 90, internally and 
by bath, has long had good repute in malarial 
jaundice. Mercurials, 565, are of doubtful util- 
ity, but good results seem to be obtained from 
small doses of calomel. 

Joints, Diseases of : 

Carbolic Acid, 524, in solution injected in syno- 
vitis with reported good results. Galvanism, 
307, highly useful in chronic affections. Mas- 
sage, 79, produces remarkable results in stiff- 
ness and deformity of joints from inflammation 
and lack of use. Oleate of Mercury and Mor- 
phia, 289, are of great service in inflammatory 
affections of joints. Nitrate of Silver in Ni- 
trous Ether, 246, an efficient application to 
check inflammation. Blisters, 615, a succes- 
sion of them about the joints, in cases of syno- 
vitis. 

Keratitis : 
Atropia, 355, to check inflammation by causing 
contraction of the vessels. Eserine, 477, lowers 
intraocular tension and relieves pain. Pilocar- 
pine, 471, is of great service in removing exu- 
dation and stopping iullammation. Zinc Sul- 
phate, 263, in solution, is an ordinary lotion in 
theso cases, and is often prescribed with atro- 
pia. Lead lotions must be used with caution. 



652 



CLINICAL INDEX. 



Labor : 

Anesthetics, 410; Chloral, 419, relieves pain and 
stops irregular action. Ergot, 885, is adminis- 
tered to hasten labor under suitable conditions, 
to cause expulsion of placenta, and to arrest 
hemorrhage. Morphia, 436, hypodermatical- 
ly, stops " false pains." 

Lactation : 
Belladonna, 35S, arrests the secretion of milk; a 
solution of atropia may be applied to the gland. 
Jahorandi, 472, increases secretion of milk. 
Phosphates, especially Phosphate of Lime, 
113, are highly useful in the debility of lacta- 
tion. 

Laryngismus Stridulus : 

Quinia, 174, administered in the interval, may 
prevent attacks that recur frequently. Nitro- 
glycerine, 493, will speedily allay the spasm. 
An Anaesthetic, 409, will at once stop an attack ; 
a few drops of ether inhaled will usually suf- 
fice. Bromides, 451, will suspend attacks if a 
sufficient quantity is given, and prevent recur- 
rences. Tartar Emetic, 266, a nauseant, will 
stop the spasms, but may induce dangerous 
depression in young children. Subsidphate of 
Mercury, 550, is as effective and safer. Ipecac, 
555, will also arrest attacks. 

Larynx, Diseases of : 
Aconite, 497, in acute catarrh, small dose of the 
tincture often administered. Inhalations, 6, 
of various astringent and anodyne substances : 
also, Insufflation, 5, of the same in powder: 
Tannin, Iodo-tannin, Iodoform, Iodoform and 
Tannin, Nitrate of Silver, Copper and Zinc 
Salts, Nitrate of Bismuth, Monsel's Iron, Alum, 
Sulphurous Acid, Bromine, Iodine, Oxygen, 
Chlorine, Quinia, Benzoin, Benzoate of Soda, 
Eesorcin, Salicylic Acid, Carbolic Acid, etc. 

Lead-Poisoning : 
Sulphuric Acid, 93, forms the insoluble sulphate ; 
Magnesium Sulphate, 564, for the constipa- 
tion, and for the cachexia a combination of 
sulphates of quinia and iron, and dilute sul- 
phuric acid. Sulphides, 213. Alum, 270, is 
an effective purgative and anodyne in lead-colic ; 
also, alum-whey. Iodides, 223, and Bromides, 
447, form soluble combinations and cause excre- 
tion of lead. For the paralysis Galvanism 
and Faradism, 303, and Strychnia, 818. 

Lentigo : 

Glycerite of Iodine, 224, locally. 

Leucocythemia : 

Oxygen inhalations, 514, improve the quality of 
the blood. Iron, 122, is of little value ; Cha- 
lybeate Springs, 132, are more useful. Phos- 
phorus, 109, and Arsenic, 146, are sometimes 
beneficial. Digitalis, 341, in young subjects 
does good. Ergot, 333, in the splenic form. 
Electricity, 306, as central galvanization, is 
very beneficial. 

Leucorrhxka : 
Alum, 2707is a cheap and useful injection ; may 
be combined with zinc and borax, in a lotion. 
Bismuth, 135, suspended by mucilage, is an 
excellent injection ; may be advantageously 
combined with Fluid Extract of Hydrastis, 



157, which is one of the best astringent applica- 
tions. Lead, 285, the acetate or Goulard's ex- 
tract properly diluted, is an excellent topical 
application. Iodo-tannin, 280, Tannic Acid, 
279, and Iodoform and Tannin, 280, 226, 
packed about the cervix, is a highly efficient 
treatment. Carbolic Acid, 524, 525, diluted 
and used with care, is an excellent deodorizer 
when the discharges are foul ; may be combined 
with the preceding lotions. MonseVs Solution, 
126, is a good application, but stains clothing. 
Common Red Wine (Ives's Seedling), 391, is a 
good lotiou. 

Lepra: 
Nitric and Nitro-Muriatic Acid, 93, for the 
accompanying indigestion. Arsenic, 144, long 
continued, renders important service. Phos- 
phorus, 110, and Pliosphates, 114. 

Locomotor Ataxia : 
Phosphorus, 110, useful to relieve pain and retard 
changes. Nitrate of Silver, 245, has done more 
good than any other remedy. Chloride of 
Gold, 240, deserves careful trial. Hyoscyamia, 
363, relieves the pains. Electricity, 309, espe- 
cially static, has given great relief. 

Lumbago : 
Acupuncture, 616, sometimes affords immediate 
relief. Aquapuncture, 617, is also very prompt- 
ly curative in some cases, and nsually relieves. 
Chloroform, 402, a few drops injected deeply in 
old cases is remarkably beneficial. Cimicifuga, 
84T, brings about relief, sometimes remarkably, 
and often fails. Galvanism, 807— descending 
. stabile and labile currents — usually effects a 
cure. Iodides, 223, are curative when disease 
is due to mercurial, plumbic, or other metallic 
poisoning. Morphia, 437, in minute quantity 
injected into the muscles affords prompt relief. 
Salicylic Acid, 538, is an appropriate remedy 
in rheumatismal cases. Hydrotherapy. 64, 65. 
hot douche to back. Emplastra, 611, the vari- 
ous anodyne and healing plasters. 

Lupus : 

Cod-liver Oil, 101, internally and locally. Iodine, 
224, in strumous and syphilitic cachexia, and 
iodoform, etc., to ulcer. Arsenic, 141, Fowler's 
solution long continued exerts a curative influ- 
ence, and arsenious acid locally. Zinc Sulphate, 
dried, 262, a manageable and efficient caustic. 
Carbolic Acid, 524, undiluted, to sore, and di- 
luted injected beneath. Chromic Acid, 621, 
a very powerful caustic, causing but little pain. 
Potassa Chlorate, 191, in powder, dusted over 
ulcer, has lately been used with great success. 
Galvano-caustic, 309, is an elegant and efficient 
topical agent. 

Lymphoma or Lymphadenoma : 
Arsenic, 146, persistently used, has good effects. 
Phosphorus, 109, has seemed to cure, but has 
usually faiied. Iodides of Iron and Man- 
ganese, 123 ; the sirup has improved the general 
state, and retarded the progress of the disease. 

Malarial Cachexia: 

Quinia, 170, is the most important remedy. Sa- 
licylate of Cinchonidia, 159, Cinchonia and 
its salts, 159, and Chinoidine, 159 Alkaloids 



CLINICAL INDEX. 



653 



of cinchona, valuable substitutes for quinia. 
Buoalyptua, 164, la an azoellent remedy for the 
convalescence and for the cachexia. TKt /ni- 
ters, 161, arc also highly useful under the samo 
conditions. For the anwmia, Iron, 121, is in- 
valuable ; it acts inoro efficiently in the cachexia 
when combined with Ars,nic, 145, which is 
also an important remedy in malarial cachexia. 
Iodide of Iron and Manganese, 129, is also a 
valuable restorative. For tho changes in tho 
spleen and liver, Compound Solution of Io- 
dine, 292, Iodide of Ammonium, 221, and oxter- 
nally to tho splenic region Ointment of the lied 
Iodide of Mercury, 289, are extremely effective. 

Mania, Acute : 
Anasthelics, 409, are sometimes required, but are 
very dangerous. Chloral Hydrate, 41S, in ap- 
propriate cases, successful in restoring mind, but 
requires care. Conia, 455, without, but espe- 
cially with, morphia hypodermatically, has some- 
times succeeded in curing acute mania with 
great motor excitement. In the acute cases 
with great restlessness Gelsemium, 465, and 
Duboisia, 365, have induced quiet and occasion- 
ally effected a cure. Ilyoscyamia, 861, has be- 
come an important remedy as a calmative and 
hypnotic. Digitalis,S4S,has proved beneficial 
in paroxysmal excitement of general paresis, 
and in acute epileptic mania. Veratrum Yiride, 
608, has acted well under the same circum- 
stances. Water-Cure, 64, as warm bath and 
pack, a valuable calmative. 

Mania, Chronic : 
Ergot, 383, is highly beneficial in chronic mania 
with lucid intervals, and in epileptic mania. 
Bromides are occasionally useful, but not suffi- 
ciently active. Morphia, 485, is the most im- 
portant remedy, but Chloral, 418, may be better 
at times. Iron, 128, in cases of an anajmic 
character, may be very useful. Digitalis, 343, 
has good effects in chronic mania, in general 
paresis, etc. Physostigma, 415, has had unex- 
pectedly good results in general paralysis. 

Mastitis: 
Belladonna, 848, stops secretion of milk and 
lessens blood-supply; a solution of atropia 
brushed over is the best form. Phytolacca, 
SOT, appears to arrest the inflammation ; the 
tincture and fluid extract are convenient for 
administration. Pilocarpus, 471, should be 
tried in severe cases with much induration. 

Melancholia : 
Opium, 435, small and frequent doses of the 
tincture, give best results. Bromides, 448, are 
sometimes highly beneficial, and yet frequently 
fail. Cannabis Indica, 878, is a useful and 
promising remedy. Caffein, 3S2, has also done 
good. Arsenic, 143, especially combined with 
minute doses of opium, and in a greater degree 
Aurum, 241, give excellent results. Chloral 
Hydrate, 418, does good as a hypnotic. Col- 
chicum, 2S3, Colocynth, 573, and other agents 
which unload the portal circulation, render im- 
portant service. 

Meningitis. (See Cerebro-spinal Meningitis.) 
For the acute condition before exudation, or dur- 



ing tho stago of excitation, Opium, 435, Is a 
remedy of tho highest Importance ; then Ergot, 
384, Gelsemium, 106, Pulsatilla, 505, Aconite, 
198, in about the order mentioned. For Hyper- 
pyrewia, Quinia, 169, Digitalis, 848, Cold 
Baths, 63. During tho exudation stage, or 
stago of depression, Ammonii Carbonate, 203, 
Turpentine, 592, Quinia, 169, in small doses. 

Menorrhagia : 
Bromide of Potassium, 452, often arrests prompt- 
ly, and is best adapted to cases of ovarian exci- 
tation. Ergot, 883, in tho menorrhagia of sub- 
involution. Cannabis Indicet, 87S, sometimes 
very useful. Digitalis, 340, in cases of mitral 
diseaso, or when arterial tension is very low. 
Ipecacuanha, 557, is remarkably beneficial in 
puerperal inenorrhagic, and may be advanta- 
geously combined with ergot. Gallic Acid, 277, 
sometimes succeeds well. Aloes, 571, is indi- 
cated in cases dependent on fecal accumulations, 
in relaxed habits. 

Mentagra : 
Copper Sulphate, 252, Zinc Sulphate, 263, and 
Silver Nitrate, 24S, lotions. 

Mercurialismus : 
Iodides, 228, combine with metal and cause its ex- 
cretion by kidneys, chiefly. Bromides, 447, it 
is asserted, have the same effects. Belladonna, 
851, is the best remedy for the ptyalism. Tan- 
nic, 279, Bed Wines, 891, and Brandy and 
water are efficient mouth-washes. Quinia, 100, 
and the Mineral Acids, 89, for the systemic 
depression. Hyoscyamia, 863, is a good rem- 
edy for the mercurial trembling. 

Metritis : 

Water, 66, hot vaginal douche has good effects. 
Carbolic Acid, 524, undiluted or diluted, ap- 
plied on cotton-wrapped probe to the lining of 
the uterine cavity. Nitric Acid, 95, the fum- 
ing acid is also applied directly to the cervical 
canal. Potassa fusa, 191, to tho uterine neck 
to cure indurations. Ergotin, 386, persistently 
used, has great value in chronic interstitial me. 
tritis. Aurum, 240, chloride, very effective in 
chronic induration of the uterus. Nitrate of 
Silver, pure and in solution, 247, is much em- 
ployed, topically, in metritis. Iodine, 226, Io- 
doform, 226, and various solutions, are freely 
used. Leeches, 619, to the cervix, give good 
results. Saline laxatives, 562, and Saline 
Mineral Waters, 195, are useful in plethoric 
subjects. 

Migraine : 
Ammonium Chloride, 203, a full dose usually 
cuts short an attack. Cannabis Indica, 37S, 
often succeeds. Guarana, 8S2, Caffein, Cuca, 
3S0, will usually arrest a seizure. Ergot, 338, 
cures the congestive form, and Amyl Nitrite, 
490, or Nitro-glycerine, 493, the ansemic. Bel- 
ladonna, 854, relieves those cases accompanied 
by vaso-motor spasm, and Digitalis, 343, those 
with low tension of the vessels and weak heart, 
or those dependent on a mitral lesion. Bro- 
mide of Potassium, 448, if sufficient doses are 
given, will arrest impending attacks. 'When 
reflex from stomach disorder, an emetic of 



054 



CLINICAL INDEX. 



Ipecac, 554, will stop ; if a symptom of intes- 
tinal indigestion, Phosphate of Soda, 112. 
Diet, 50, is of the first consequence in the cases 
of stomach origin. 
Myalgia : 

Ammonium Chloride, 203, sometimes affords 
relief. Cimicifuga, 847, often cures, but also 
fails. Electricity, SOT, rarely fails to cure; 
galvanism and static electricity, and very rap- 
idly interrupted faradic, may alike succeed. 
Counter-irritation by Firing, Aquapuncture, 
617, and Acupuncture, 616, will usually relieve. 
When a rheumatic condition is the cause, Sa- 
licylates, 538, will cure ; when a mineral poi- 
son, the Iodides, 223. Massage, 79, will usu- 
ally do good. 
Myelitis : 

When idiopathic, Ergot, 334, Chloride of Bari- 
um, 206, Galvanism, are the most appropriate 
remedies ; when specific, Mercury, 235, or the 
Iodides, 223. Hydrotherapy, 64, especially 
the tepid rubbing-wet pack. Massage, 79, to 
the damaged muscles. After acute symptoms, 
or in chronic cases, Strychnia, 318, Picrotox- 
ine, 324, and similar excitants are proper. 
N.evi : 

Chromic Acid, 621, readily destroys with little 
pain. GaPvano-causty, 334, is a good means 
of removing them. Nitric Acid, 94, is also an 
efficient caustic. Collodion, 625, by mechani- 
cal compression in drying, will sometimes cure 
them 
Narcosis. (See Antidotes.) 

Ammonia, 202, by inhalation, especially by in- 
travenous injection, in failure of the hearfs ac- 
tion. Oxygen inhalations, 514, in chloroform 
narcosis. Faradism, 295, to stimulate the re- 
spiratory center by reflex irritation, and the re- 
spiratory muscles directly. Amyl Nitrite, 430, 
by inhalation in cardiac failure. Water, 65 ; 
the cold douche and cold affusion in cerebral 
narcosis, prussic-acid poisoning, and sunstroke, 
etc. Heat in alternation with cold. Emetics, 
Apomorphia, 502, Sulphate of Copper, 251, 
Sulphate of Zinc, 260, etc. 
Neuralgia : 

Aconite, 499, when there is febrile excitement ; 
Aconitia, 500, is particularly effective in neu- 
ralgia of the fifth nerve. Alcohol, 390, in suf- 
ficient quantity, is an anodyne, but the alcoholic 
habit is quickly formed. Anaesthetics, 408, 
promptly relieve. Cod-liver Oil, 100, is of great 
value as a nutrient. Chloroform, by deep in- 
jection, 402, is very effective in old neuralgia?. 
Croton-Chloral, 421, is useful in neuralgia of 
the fifth. Morphia, 437, subcutaneously, is the 
most efficient remedy for the relief of pain. 
Aquapuncture, 617, often remarkably beneficial. 
Belladonna, 354, 356, especially atropia subcu- 
taneously, in tic-douloureux and sciatica, but 
full doses must be administered. Arsenic, 
143, benefits by improving the nutrition. 
Bromides, 450, are useful in some cases ; Cim- 
icifuga, 347, and Gelsemium, 465, do good in 
simple neuralgia of the fifth, and in ovarian 
neuralgia. Galvanism, 306, 309, is, next to sub- 



cutaneous injection of morphia, the most de- 
cidedly curative agent. Massage, 79, gives much 
relief. Copper. Ammoniated, 252, in neural- 
gia of the fifth, has been revived lately. Iron, 
123, is required in anaemia, the usual condition. 
Phosphorus, 109, has proved curative in suit- 
able cases, if pushed. Nitrite of Amyl, 490, 
by inhalation, and Nitro-Glycerine, 493, by the 
stomach in neuralgic dysmenorrhea. Strych- 
nia, 318, long continued in depressed states of 
the nervous system. Turpentine, 592, in re- 
flex cases. Veratria, 503, the ointment in su- 
perficial neuralgia. The Antiseptic Oils, 548, 
locally. Chloral and Camphor, 420, with 
Morphia, applied to tho seat of pain. Wet 
Pack, 65, 70, in sciatica, etc. 

Nymphomania : 
Bromide of Potassium, 452, but large doses are 
requisite. Camphor, 368, and Camphor Mon- 
obromata, 366, must also be given in large 
doses. Tobacco, 481, carried to nausea. 

Obesity : 
Banting System, 35. Alkalies, 183, and Alka- 
line Mineral Waters, 194. Bromide of Am- 
monium, 447. Potassa Permanganate, 129, 
for the attendant dyspepsia The Vegetable 
Acids, 208. 

Onychia : 
Chloral, 420, a solution applied locally. Iodo- 
form, 225, in powder or ointment. Nitrate of 
Lead, 253, as powder, in glycerine, or as oint- 
ment. 

Ophthalmia : 
Mercury, 233. Calomel dusted over the conjunc- 
tiva. Tannin, 279, also dusted over the mem- 
brane. Alum, 272, in solution in rose-water. 
Atropia, 355. Eserine, 477, to diminish intra- 
ocular tension. Pilocarpus, 471. Conium, 
456, the alkaloid conia or the succus, in blepha- 
rospasm. Nitrate of Silver, 24S, Zinc Sul- 
phate, 263, and other mineral astringents. 

Orchitis : 
Ice, 65, in a bag kept applied. Iodine, 224, tinct- 
ure, locally. Mercury, Oleate of, 23S, painted 
over. Nitrate of Silver, 246, in nitric ether, 
painted over. Ammonium Chloride, 203, in 
solution with alcohol. 

Otourhoia : 
Lead, 258, lotions of. Silver Nitrate, 243, in 
solution. Tannin, 279, the glycerite, locally. 
Zinc Sulphate, 263. Mercury, 238, the brown 
citrine ointment Cadmium, 268, in solution 
in water. 

Ovarian Cysts : 
Iodine Injections, 226, of tincture or compound 
solution, but adapted only to unilocular cysts. 
Electrolysis, 808, also only in single cysts. 

OXALURIA : 

Nitro- Muriatic Acid, SO, has special utility. 
Nitric Acid, 90, before meals in acid indiges- 
tion and excess of uric acid. 
OZiENA : 

Bromine, 516, inhalations of vapor very cautious- 
ly. Carbolic Acid, 524, solution injected, 
spray inhaled. Carbolate of Iodine, 221 ; 
iodine and carbolic acid vaporized and inhaled. 



CLINICAL INDEX. 



655 




Iodoform, 224, vaporized or solution in ether 
applied. Iodine, 221, inhaled; llicUi-omat, of 

Potaasa, 191, eolation Injected. Iodoform, 
lodo-tanntn, bismuth, zinc oxide, resorcin, tby- 
mol, and similar agents applied by Insuffla- 
tion, 4. 

Pain. (See Nw i:\lgia.) 
Opium, 436, in any form, but especially morphia 
6ubcntaneously, best of all agents for the relief 
of pain. Belladonna, 854, especially atropia 
alone or in combination with morphia. Anas- 
thetics. 410, five Immediate relief. Aconite, 4'.)9, 
and its alkaloid, aconitia, relieves pain, especial- 
ly of fifth nerve. Cannabis Imlica, 87S, has 
slight anodyne properties. Chloral, 419, does 
not relieve pain directly, but by stopping spasm, 
unless in dangerous narcotic doses. Croton- 
C/doral, 421, induces anaesthesia of fifth norvc. 
Gelsemium, 468, has feeble anodyne properties; 
Cimicifuga, 847, even less. Galvanism, 304, 
has decided power to relieve pain. In noctur- 
nal pain, Iodides, 222, havo remarkable effects. 
Aquapuncture, CI", Acupuncture, 016, Blis- 
ters, 615, and Heat and Cold, 70, relieve pain in 
varying degree. 

Paralysis : 
Cod-liver Oil, 100, favors the restoration of dam- 
aged nerve-elements. Phosphorus . 109, with 
or without oil, as a restorative of nerve-matter. 
Strychnia, 81S, 820, an important stimulant, 
but must be used after local troubles in the 
nerve - centres have subsided. Picrotoxine, 
824, employed under similar conditions to 
strychnia. Galvanism and Faradism, 303, 
are first in importance as remedies in the diag- 
nosis and treatment of paralysis; especially 
adapted to the "myopathies of spinal origin." 
Massage, 79, an important adjunct to other 
treatment. Hyoseyamia, 3C3, is very useful in 
paralysis ngitans. Eserine, 470, is of great 
service in paralysis of the third nerve. In the 
paralysis due to gummata, Iodides, 223, effect 
surprising cures. Ergot, 834, in vesical paraly- 
sis the result of over-distention. 

Parasites : 
Acetic Acid, 203, in pityriasis versicolor and 
other parasitic skin-diseases. Sulphurous Acid, 
210. destroys sarcina and itch-insect; also Sul- 
phides, 213. Mercury, 23S, the corrosive chlo- 
ride, is very effective in the various parasitic 
skin affections. Salicylic Acid, 534, Carbolic 
Acid, 521, Resorcin, 541, Boracic Acid, 548, 
Benzoates, 545, are useful in same group of af- 
fections. Glycerine destroys trichina. AnViel- 
iiiintics, 5S2, contain the most effective para- 
siticides. 

P&hphighs : 
Arsenic, 144, cures the chronic form. Bella- 
donna, 355, for the acute stage. 

Peritonitis : 
Aconite, 49S, for the febrile movement. Chloral, 
41S, for restlessness and delirium, anjl to de- 
press the temperature. Opium, 433, is the 
remedy of highest importance, is best adminis- 
tered as morphia hypodermatically. Turpen- 
tine, 591, ia puerperal peritonitis with de- 



pression and tympanitis. Quinia, 107, in full 
doses, with or without morphia, is of gnat 
value before the exad&tlve Btage, Ammonia, 
203, Pottuk Salts, 1-4, during exudation. For 
external treatment; Ilnbifacients, 010, Ice- 
bug, 05, to abdomen ; also Heat, 70, and Poul- 
tiees, 027. 

Pernicious Fever : 
Ainyl Xitrite, 490, by inhalation to prevent rigor. 
Pilocarpus, 411, Quinia, 172, in large quantity 
by the stomach op hypodermatically { Morphia, 
434, also, if not contraindicated. Chloroform, 
402, in time to prevent the depression of the 
cold stage. 

Perspirations : 
Aromatic Sulphuric Avid, 93, is an ancient 
remedy, but in several respects objectionable. 
Atropia, 855, is one of the most useful reme- 
dies for "night-sweats," and locally applied for 
sweats in various local situations. Picrotox- 
ine, 324, a minute dose, will stop for several 
nights the sweats of consumption. Muscarine, 
512, is also a serviceable remedy. For sweating 
of the feet, Salicylic Acid, 53S, in powder, 
dusted over the feet and stockings, is probably 
the best remedy; may also be used in lotion 
with borax. Permanganate of Potassa, 129, 
is an elegant toilet deodorant in fetid sweating 
of axilla; and feet. Oxide of Zinc, 201, with ex- 
tract of belladonna in pill, is an ordinary reme- 
dy for night-sweats ; also Gallic Acid, 278. 

Phagedena : 
Bromine, 517, pure, applied with a glass rod, is a 
good escharotic, but not easily managed owing 
to its volatility. Carbolic A cid, 523, superficial 
in its effects, but very useful in mild cases. 
Chlorate of Potassa, 191, in powder a manage- 
able and efficient remedy. Salicylic Acid, 539, 
in powder, to the sloughing and normal tis- 
sue adjacent. Sesorcin, 540, in powder, ap- 
plied in the same way, and Boracic Acid, 543, 
accomplish good results by changing the char- 
acter of the local action. Chloride, of Zinc, 
2G2, and Nitric Acid, 94, are powerfully de- 
structive. Internally : Iodide of Iron, 122, 
Quinia, 16?, Phosphates, 118, and the tonics 
and restoratives in general. 

Pharyngitis, Follicular : 
In the acute inflammation — Aconite and Bella- 
donna, 497. For local application — Tannin, 
279, Tannin and Iodoform, 226, Iodoform, 
226, in powder or ethereal solution, Cubebs, 
596, in powder — the powders by insufflation. 
Nitrate of Silver, 246, in solution, painted 
over the surface. Hydrastis, 156, the fluid 
extract, an excellent topical application to mu- 
cous membrane, inflamed. 

Phlegmon : 
Carbolic Acid, 524, a solution injected as an 
antiseptic. Iodine, 226, the tincture or com- 
pound solution injected after removal of the pus 
to prevent decomposition. Nitrate of Sil/cer. 
24S, a solution in nitrous ether painted over 
the inflamed area, maj' abort the abscess. Sul- 
2>hides, 212, promote formation of matter, or 
extrusion and healing. 



656 



CLINICAL INDEX. 



PnOSPHORUS-PoiSONINO '. 

Sulphate of Copper, 103, forms insoluble phos- 
phide and induces active emesis. Turpentine, 
103, the acid or French, or old turpentine, ex- 
posed to or mixed with air, and not rectified 
fresh turpentine. Transfusion, 104, to replace 
damaged blood-corpuscles, has saved life. 

Phthisis : 
Alcohol, 395, an important remedy when it pro- 
motes appetite and digestion, and increases the 
body-weight. Aliment, 33, fresh blood, fats, 
and nitrogenous food. Bensoate of Sodium, 
546, in spray, has been proposed as a specific, 
and already discredited. Chloride of Calcium, 
189, has had remarkably good effects in some 
cases. Cod-liver oil, 99, is both a valuable 
food and a remedy ; ether aids its digestion by 
increasing the pancreatic juice, and quiets the 
stomach. Mineral Acids, 92, especially nitro- 
muriatic in large doses, greatly improve the 
condition of some cases and retard the progress 
of the disease. Carbolic Acid, 522, has been 
used with great advantage by inhalation to de- 
stroy the fetor of the expectoration, and to act 
on the local morbid process ; systemically, the 
acid helps digestion and stimulates the assimi- 
lation. Creosote, 522, has been used with re- 
markable success recently. Phosphates and 
Hypophosphites, 114, Cuca, 330, with or 
without cod-liver oil, have good effects in the 
more chronic cases. Arsenic, 142, improves 
digestion and the formation of tissue, and in- 
creases the respiratory capacity. Strychnia, 
819, checks the vomiting, and is a valuable re- 
spiratory stimulant. For the night-sweats, 
Picrotoxine, 324, Atropia, 355, and sometimes 
Pilocarpine, 471. For the cough, Prunus 
Virginiana, 152, Codeia, 43T, Bromides, etc. 

Pityriasis : 
Acetic Acid, 203, will destroy the parasite and 
cure. Borax, 543, is a good application in 
pityriasis of the scalp. Bichloride of Mercury 
238, in solution, if strong enough, is a certain 
cure for pityriasis versicolor. Oleate of Mer- 
cury, 238, may also succeed. Carbolic Acid, 
524, and Myrtol, 548, will destroy the parasite 
of pityriasis versicolor. The Sulphides, 213, 
sulphide of potassa in lime-water is an excellent 
application. 

Pleuritis : 
Aconite, 497, is a valuable remedy for the febrile 
stage. Bloodletting, 620, by cups or leeches, is 
a good expedient in the initial stage in pleth- 
oric subjects. Blisters, 614, are useful at two 
periods : at the onset and as resolution begins. 
Digitalis, 343, is an antiphlogistic, adapted to 
the preexudative stage. Iodide of Potassium, 
220, is useful to promote absorption of the exu- 
dation, and tincture of iodine or compound solu- 
tion injected to prevent reaccumulation of fluid. 
Quinia, 174, is useful both to reduce tempera- 
ture and check exudation. Morphia, 433, is 
the most important remedy until exudations 
occur ; quiuia and morphia in sufficient quan- 
tity at the outset may abort. Chloral, 418, is 
extremely useful when there are restlessness and 



delirium. Pilocarpus, 471, causes absorption 
of exudation. 

Pneumonia : 
Aconite, 497, Veratrum Viride, 502, and Digi- 
talis, 343, very valuable antipyretics and anti- 
phlogistics for the stage of congestion. Car- 
bonate of Ammonia, 203, Iodide of Ammoni- 
um, 220, for the liquefaction of the exudation. 
Turpentine, 592, a valuable stimulant when 
circulation is feeble, and in gangrene. Quinia, 
167, an important remedy under two condi- 
tions : in large doses during congestion, and in 
small tonic doses as a stimulant when depres- 
sion comes on. Wet Pack, 65, and the cold 
bath, the latter as a remedy for the infiamma 
tion, according to J urgensen, the best. Senega 
and Serpentaria, 375, stimulant expectorants. 
Muscarine, 512, is a highly promising remedy. 
Blisters, 614, useful at onset, and to promote 
resolution. 

Polyuria : 
Dry-diet, 36, of great value. Chloride of Gold, 
241, persistently used, an important remedy. 
Opium, 488, large doses are necessary, and 
therefore extreme danger of forming a habit. 
Ergot, 334, the most beneficial remedy thus far 
known probably. Pilocarpus, 472, has been 
used with success. 

Porrigo : 
Manganese, 129, an ointment of the oxide. Ole- 
ate of Mercury, 238, has succeeded. Iodide- 
of-Lead Ointment, 258, in chronic cases. 

Prostate, Hypertrophy of- 
Alkalies, 185, in acid urine, and Benzoate of Am- 
monia, 545, for acid urine. Tincture of Iodine, 
226, injected .through the walls of the rectum. 
Iodoform, 225, by suppository in the rectum. 
Sulphides, 212, are supposed to induce absorp- 
tion. Injections of Ergotin, or Ergot inter- 
nally, 336, the most certain means of reducing 
the size of the organ. 

Prostorrhcs a : 

The Urino- Genital Semedies, 592, notably Can- 
tharis, Turpentine, Cubeb, and Copaiba 
Hydrastis, 157, fluid extract, internally and ap- 
plied locally. Tincture of Chloride of Iron, 
126, when there is much debility. Bromide of 
Potassium, 451 when there are irritability and 
excitement. Ergot, 334, when relaxation exists. 

Peurigo : 
Carbolic Acid, 524, locally and also internally. 
Alkaline Warm Batlts, 190, at bed-hour. Bel- 
ladonna, 855, internally, sometimes relieves 
remarkably. Potassium Cyanide, 4S3, in so- 
lution, is effective, but must be used with cau- 
tion. Pilocarpus, 472, does good when skin 
is dry and harsh. Galvanism, 307, has special 
value in cases of neurotic origin. Sulphides, 
212, afford relief in bath or as an ointment. 

Pruritus Vulvae: 
Borax, 190, a saturated solution freely applied ; 
also Potassium Bicarbonate, 190, in solution. 
Bichloride of Mercury, 23S, in solution of suf- 
ficient strength. Cyanide of Potassium, 437, 
as an ointment or in solution, if strong enough, 
relieves greatly, but must be used cautiously; 



CLIN'ICAL INDEX. 



651 



nlso Hydrocyanic Acid diluted, which may be 
prescribed in lotion, with borax. Nltrat 
. Si/rer, 248, ii solution painted on the affected 
parts, gives great relief. Sulphites, 810, also as 
a lotion. Oltaii ntf Hftrcury and Morp/Ua,28$. 

Psoriasis : 
Cod-livtr Oil, 101, of the greatest value both in- 
ternally nnd locally In coses of strumous origin. 
Arsenic, 144, in chronic oases; may Increase 
tho discaso at first, but persistently used may 
effects cure. Phosphorus, no, acts similarly 
to Arsenic, and may accomplish better results. 
Locally— Nitrate of Silver, 247, Lead — oint- 
ment of the Iodide, 253, CopHs, 150, especially 
useful in Psoriasis of the tongue, and Sulphur 
Baths, 212. 

I'tyai.ism : 
Belladonna, 851, very effective in mercurial, and 
of pregnancy. Duboisia may be substituted. 
Locally— Tannin, 27$, Brandy, 891, and the 
Vegetable Astringents, 273. 

Puerperal Convulsions : 
Anaesthetics, 409, especially chloroform; the re- 
lief is temporary, but time is gained for other 
measures. Chloral, 419, in considerable doses 
is useful. Morphia, 436, hypodermatically, Is 
the most valuable agent in the uremic form, 
but full doses are necessary. Amyl Nitrite, 
4U0, by inhalation, may do good in cases char- 
acterized by high tension of the vessels. Blood- 
letting, 619, is necessary when there is cerebral 
congestion. Bromides, 449. 

Puerperal Fever : 
Quinia, 169, in large doses, first in importance. 
Opium, 434, when there are wakefulness and 
delirium, especially when local peritonitis ex- 
ists. Salicylic Acid, 535, and the Salicylates, 
Pesorcin, 541, and Carbolic Acid, 523, are 
remedies of great value. Turpentine, 591, 
when there is much tympanites or depression. 
Potassa Permanganate, 129, has been used 
with success internally. 

Puerperal Mania: 
Anaesthetics, 409, may be necessary in violent 
cases. Bromides, 448, will quiet, in cases with 
tendency to cerebral congestion. Chloral, 41S, 
is a highly serviceable hypnotic, but its persist- 
ent use in anaemic cases is harmful. Duboisia, 
865, and Ilyoscyamia, 363, are probably the 
best hypnotics when there are much excito- 
rnent and restlessness, as well as wakefulness. 
Chalybeates, 123, and Quinia, 168, are neces- 
sary when there is debility. Morphia, 435, 
under some circumstances is the best hypnotic. 

Puerpeeal Peritonitis : 

Opium, 433, is the most important remedy, and 
is probably curative. Quinia, 16S, in consid- 
erable doses, is next in value; a combination of 
quinia and morphia. Turpentine, 591, is indi- 
cated in a condition of systemic depression and 
when tympanites is present. Ice, 60, Heat, 70, 
to the walls of the abdomen. 

Purpura : 
Digitalis, 841, to overcome the low tension. 
Ergot, 332, slows the heart and raises the ten- 
sion, and thus checks transudations. Sulphuric 
43 



.tad, 98, (in/lie Arid, 277, Acetate of Lead, 
257, ore astringents of more or less value. Tur- 

jjenlini. Mil, is of great vilue usually. Iron, 
121, is usually indispensable, especially the tinct 

hit (■( the chloride, 

Py.kmia : 
Quinia, 189, in large doses, Suliaylic Arid, 585, 
Resoroin, Ml, and the Antiseptics in general, 
ore useful in varying degree. Alcohol, 890, 
and tho Malt Liquors, 397, have an important 
place. 

Pyelonephritis : 
Eucalyptus, 154, and the L'rinogenital Heme- 
dies, especially Cantharis, 609, Turpentine, 
592, Pipsissetva, 601, Erigeron, 600, Gallic 
Acid, 277. 

Remittent Fever : 

Quinia, 171, curative in efficient doses. Resor- 
cin, 541, Salicylic Acid, 535, and Benzoates, 
546, come next. 

Rheumatic Arthritis ■ 
Lithium, 190, and its salts. Iodides, 223, when 
the disease is due to syphilitic, mercurial, or 
plumbic poisoning. Colchicum, 288, when the 
gouty or rheumatic diathesis underlies the dis- 
ease. Cod-liver Oil, 100, internally and locally, 
is adapted to all forms, and one of the best of 
remedies. Arsenic, 145, is beneficial in cases 
of simple character. 

Rheumatism, Acute : 
Aconite, 49S, tincture of tho root, for the lever. 
Water, 60, 62, cold baths for the condition of 
hyperpyrexia. Arnica, 467, a remedy for sub 
acute cases. Bromide of Ammonium, 446; 
a remedy advised by Da Costa. Bromide of 
Lithium, 190, one of the best of the lithia salts. 
Trimethylamine, 468, of doubtful value. Sal- 
icin, 534, Salicylic Acid, 536, and the Sali- 
cylates, Benzoates, etc., 546, now much em- 
ployed in the treatment of acute rheumatism. 
Alkalies, 184, a plan of treatment once very 
popular and still pursued. Iron, 122, tincture 
of the chloride in full doses a valuable remedy 
in weak subjects. Blisters, 615, a succession 
of, around tho affected joints, give relief and 
shorten the disease. Mineral Acids, 93, have 
been warmly advocated. Lemon-juice, 209, 
an adjunct to more effective remedies, especially 
to potash salts. 

RnEUMATisM, Chronic : 
Alkaline Mineral Waters, 194, Sulphurous 
Waters and Baths, 213, 216. The Turkish 
Bath, C9, Cod-liver Oil, 100, a very important 
remedy. Colchicum, 2S3, in the so-called 
gouty form. Guaiac, 286, is sometimes useful. 
Xanthoxylum, 292, and Cimicifuga, 347, give 
relief in tho muscular form, and arc less benefi- 
cial when there are joint changes. Iodides, 223, 
produce excellent results in the cases due to 
metallic poisoning. Manganese Sulphate, 127, 
does good in cases of gouty antecedents. Lith- 
ium and its Salts, 190, afford tho best results 
in uric-acid diathesis. 

Rickets : 
Aliment, 48, food rich in phosphates, oils, and 
lime. Cod-liver Oil, 98, is a most important 



G58 



CLINICAL INDEX. 



agent in the process of regeneration . Plios- 
phate.% 118, especially the lacto-phosphate of 
lime, and Iron, 128, especially the sirup of the 
iodide. Phosphorus, 109, induces an hyper- 
trophy of bony tissue, and should therefore be 
carefully tried in this disease : it may be advan- 
tageous'y given in cod-liver oil. 
Goseola : 

Belladonna, 355, is a suitable remedy when any 
remedy is needed, and Inunctions of Oil, 98, 
allay the cutaneous irritation. 
Gubeola: 

Aconite, 493, and Digitalis, 342, are important 
antipyretics and to relieve the catarrhal pro- 
cess. Carbonate of Ammonia, 203, has the 
greatest value in the catarrhal pneumonia when 
a complication. Quinia, 169, is highly useful 
for the adynamia, and in large doses when 
catarrhal pneumonia comes on. Oil Inunc- 
tions, 93, allay irritation of the skin and lessen 
the febrile heat. 
3cabies : 

Sulphur Baths, 212, Sulphites, 212, and Sul- 
phides, 212, freely and faithfully used, are very 
effective. Carbolic Acid, 534, locally destroys 
the parasite ; also, Cajeput Oil, 54S. Corro- 
sive Chloride of Mercury, 238, if strong 
enough, is very effective, but caution is neces- 
sary. Manganese, 129, an ointment of the 
oxide. Sulphate of Copper, 252, a lotion of, 
may be used successfully. 
Soaelet Fever : 

Aconite, 49S, for the fever and local inflamma- 
tions. Digitalis, 842, a very important reme- 
dy as antipyretic and diuretic. Belladonna, 
353, when the eruption is imperfect or bluish, 
the peripheral circulation feeble, and the heart's 
action depressed. Oil Inunctions, 98, dimin- 
ish irritation of the skin and lessen tempera- 
ture. Salicylic Acid, Benzoate of Sodium, 
546. Pesorcin, 541, and Carbolic Acid,»523, 
antiseptics and antipyretics ; spray to the 
throat, :and internally for septic infection. Car- 
bonate of Ammonia, 203, of great value as a 
remedy and as a stimulant to the depressed 
circulation. Quinia, 169, employed under two 
conditions— as antipyretic and tonic. Water, 
62, cold baths and pack, for hyperpyrexia and 
to develop the eruption in the fulminant cases. 
Aqua Chlorinii, 515, is a useful gargle and 
deodorant mouth-wash. Hydrochloric Acid, 
92, internally, and diluted as a lotion for mouth 
and throat. 
Sciatica : 

Atropia, 35C, injected subcutaneously in the 
neighborhood of the nerve, but the physiologi- 
cal effects must be fully induced. Morphia, 
437, subcutaneously with or without atropia, is 
the most effective treatment. Galvanism, 805, 
next to morphia, is the best method of cure. 
Aqnapunctune, 617, gives great relief in re- 
cent cases. Acupuncture, 616, sometimes re- 
lieves. Chloroform, 402, by deep injection in 
old cases is surprisingly effective. Nitrate of 
Silver, 249, in solution, injected near to the 
nerve-trunk, is curative in some old cases re- 



sisting other means. Iodides, 223, should be 
used in cases of syphilitic, plumbic, or mercu- 
rial cachexia. Turpentine, 592, has occasion- 
ally succeeded ; also Guaiac, 286. 

Scleroderma : 
Cod-liver Oil, 101, the most important remedy. 
Phosphates and Hypophosphites, 114, with or 
without cod-liver oil. Phosphorus, 114, in cod- 
liver oil. Galvanism, 807, ceDtral galvaniza- 
tion. 

Sclerosis, Spinal : 
Nitrate of Silver, 245, very beneficial. Chloride 
of Gold, 241, probably not inferior to silver. 
Galvanism, 304, and Static Electricity, 309, 
Iodides, 222, when there are specific lesions, 
and in mineral poisoning. Baths, 65, the rub- 
bing wet pack. 

Scrofula : 
Cod-liver Oil, 99, and Inunctions of Oil, 9S. 
Phospltates, 114, to improve the nutrition. 
Iron, 123, and Chalybeate Waters, 132. Io- 
dides, 221, of iron and manganese, especially. 
Still ingia, 2SS, Sanguinaria, 291, and Sarsa- 
parilla, 2S6, promote the activity of the vegeta- 
tive functions and improve nutrition. 

Sea-sickness : 
Atropia, 351, subcutaneously, in minute quantity. 
Chloroform, 401, a few drops by the stomach, 
frequently. Chloral, 417, probably the most 
effective remedy, but must be given before de- 
cided nausea sets in. Champagne, 3S9, iced 
in small quantity. Morphia, 431, minute doses 
subcutaneously. Amyl Nitrite, 490, by inhala- 
tion, and Nitro-Glycerine, 493, by the stomach, 
are very useful. Bitters, as Calumba, 150, and 
Tincture of Nux Vomica, 316, also sometimes 
succeed. 

Seboerhoea : 
Zinc Oxide, 263, ointment. Potassat Liquor, 
190, locally and internally. Glycerine, 623, 
persistently continued by the stomach. 

Septicemia : 
Quinia, 16S, in large doses, as an antipyretic and 
antiseptic. Salicylic Acid, 535, Resorcin, 541. 
and Benzoates, 546, are employed for the same 
purposes : to keep down the temperature and to 
destroy septic materials. Bromine, 517, Car- 
bolic Acid, 523, and Chlorine, 515, Boracic 
Acids, 543, the Antiseptic Oils, 548, Potassa 
Permanganate, 129, are all used locally to 
destroy sloughing and gangrenous parts, to 
destroy foul odors, and to change the character 
of the surface. Cold Baths, 62, for hyperpy- 
rexia, and Hot Water, 66, for wounds. 

Skin-Diseases : 

Oils and Fats, 99, by inunction and locally. Ar- 
senic, 144, in chronic, scaly skin-diseases. Phos- 
phorus, 110, in place of arsenic and under the 
same conditions. Iodides, 223, when syphi- 
litic, mercurial, plumbic, or other metallic poi- 
sons underlie the local morbid process. Mer- 
cury, 235, 23S, of great value in secondary 
syphilitic cutaneous affection. Quinia, 174. 
in ecthyma, erythema nodosum, and when de- 
pression of the vital forces exists. Atropia, 
355, is highly useful in certain cutaneous neu- 



CLINICAL INDEX. 



G.->9 



roses, and Id Blmple vascular lesions. Ptti 
jinx, 472, when the sklo-secretlons ere deficient, 
and in alopecia pltyroldes. Saraapa/riUa, 888, 
has long been oelebratod in syphilitic sod stru- 
mous affections of the skin. Mint rat Aoi 
In diseases secondary to stomachal and Intestinal 
Indigestion. EUctrieity, 807, in the neuroses 
of the skin. Locally, the salts of Zine, 
Lead ami Mercury, 886, 7tinnioAfiid,i19,ae 
glyc.-ritc or In powder, Carbolic Acid, 524, and 
Iodine, 226, are freely used In various acute 

and chronic affections. Stains of Xitrat, of 
Silver, 24-. arc removed by a solution of cyanide 
of potassium, iodino, and water. 

SrEHM.VTOKKIliK.V: 

Atrojiia, 855, Ergot, 834, and Digitalis, 844, 

when the genitals are relaxed, the erections 
feeble because of deficient filling of veins of 
erectile tissue, and the ejaeulator muscles paret- 
ic. Cimicifuga, 347, acts similarly, but less 
strongly. - N "■'' P&m<off,817, or strychnia, la in- 
dicated when a stimulant and tonic are required, 
and Cunt/torts, 609, when a stimulant merely 
is needed. Iron, 120, tincture of tho chloride, 
when anrcmia is a marked feature, and Art 
1 15, when a systemic tonic, as well as geDit.il 
stimulant. Bromide of Potassium, 451, Lu- 
2>u/ine, 442, and Camphor, 30?, when a genital 
sedative is indicated. Locally, Nitrate of Sil- 
ver, 248, Hydrastis, 157. fluid extract, Tannin, 
279, and vegetable and mineral astringents. 

Spina Bifida : 
Iodine, 226, the tincture injected into the sae. 
Collodion, G25, in drying contracts and mechani- 
cally compresses. 

Spinal Ihritation- : 
Electricity, 804, is an efficient means of allaying 
the pain and tCDderness. Strych nia, 320, one 
of the best tonics for the primary assimilation, 
and stimulant for the depressed nerve-centres. 
Ergot, 334, is required when active hyperemia 
is present. Bromide of Potassium, 44s, does 
good under the same conditioa. Mitoht I'.'s 
Cure, 80, by massage, rest and faradism, prob- 
ably the best treatment. 

Spleen, Diseases op : 
Remedies acting on the spleen, are. in annjmia, 
Iron, 121, Manganese, 129. and Arsenic, 145; 
in vascular dilatation. Ergot, 333, Quinia, 173, 
Belladonna, 351, Muscaria, 512, Resorcin, 
541. The most efficient external applications 
are : Cold Affusion, GO, which causes contrac- 
tion of the splenic vessels, Ointment of the Red 
Iodide of Mircnry, 221, which, if properly ap- 
plied, causes a rapid reduction of simple hyper- 
trophy, Ointment of Iodide of Lead, 25^. 

Sterility : 
Aurum, 240, chloride of gold and sodium, when 
duo to chronic interstitial metritis. Phospho- 
rus, 110, when simple functional debility in 
male. 
Stomatitis : 
Alcohol, 891, Brandy-ami- Wati r an excellent as- 
tringent wash. Bismuth, 133, in powder free- 
ly applied. Acids, S9, hydrochloric, applied 
directly to ulcers. Eucalyptus, 154, Hydras- 



tis, 158, Rutjiis, 274, Krameria, 278, and other 

vegetable astringents, the Moid extracts being 

applied pure or variously diluted to I he affected 

parts. Potassium Chlorate, 188, the most val- 
uable application, and especially systemic rem- 
edy. 
Strangii:y : 

Opium, 440, the tincture by enema, or better, 
morphia subcntancously. Gelsemiwn, 405, 
Aconite, 198, Veratrum Viride, 502, and Bro- 
il t, 152, afford relief in varying degree. For 
vesical strangury, Cantharidis Tincture, 
Turpentine, 592, and various urine-genital 
remedies. 
Strictiue : 
Electrolysis, 808, cures spasmodic, and, some 
affirm, can cure a permanent stricture. 

StrYCIINIA-I'oISoMNi; : 

Entities or Stomach- Pump; Tannin, Com- 
pound Solution of Iodine, chemical antidotes. 
Chloral, Chloroform by inhalation, Nicotic 
subcutancously, physiological antagonists. 
Best, Artificial Respiration, and Galeae 
311. 

Suppuration : 
Alcohol, 390, a powerful antiseptic and antipy- 
retic, and, externally, a valuable antiseptic 
dressing. Carbolic Acid, 525, and Lister's 
antiseptic method. Quinia, 174, in full doses, 
as a tonic. Sulphides, 212, small doses fre- 
quently mature abscesses, and, under some cir- 
cumstances, abort them; also, Sulphurous 
mineral Waters, 216. Phosphates, 118. and 
Lime Salts, 1S9, to repair wasto by suppura- 
tion. Iodides of Iron and Manganese, 128, 
the sirup of, in the systemic depression caused 
by suppuration. 

Sweating. (Hyperidrosis — see Perspiration.) 
Mineral Acids, 98, especially aromatic sulphuric 
acid. Oxide of Zinc, 261, in night-sweats of 
phthisis, especially with extract of belladonna. 
Gallic Acid, 27S, restrains sweating. Atropia, 
356, is a powerful means of arresting perspira- 
tion ; also, Duboixia, 305, and especially Pi- 
crotoxin, SH, Pilocarpus, 471, Resorcin, 641, 
and Salicylic Acid, 535, cause sweating, and, 
under some conditions, arrest it. 

Sycosis : 
Carbolic Acid, 524, internally and externally. 
Oleate of Mercury, 283. 

Synovitis : 

Cod-liver Oil, 100, is useful in strumous and 
debilitated constitutions. Nitrate of Silver, 
246, in nitrous ether, painted over the joiot. 
Carbolic Acid, 524. solutiou injected into the 
joint. Oleate of Mercury and Morphia, 233. 
Massage, 79. 

Syphilis : 
Baths, 60, 71, Turkish baths, wet packs, and 
vapor-baths, are very important in promoting 
excretioD. Denutrition,86,hung6T-corG. 
liver Oil, 101, useful io chronic cases and 
broken-down constitutions. Mercury, 235. the 
great remedy for constitutional syphilis — by 
stomach, by inunction, by fumigation, or sub- 
cutancously. Iodides. 222, in constitutional, 



G60 



CLINICAL INDEX. 



certain forms of secondary and tertiary disease, 
is unrivalled in efficacy. A urutn, 289, comes 
into use after iodides and mercury, to which 
it is greatly inferior. Iron, 122, especially the 
iodide, in sloughing phagedsena and in depressed 
states of the system at all stages. Iodoform, 
222, as a local application to chancres. Car- 
holia Acid, 524, Salicylic Acid, 539, Boracic 
Acid, 543, Benzoin, 545, Chlorate of Potassa, 
191, in powder, are valuable local applications 
to syphilitic sores, abscesses, discharging bu- 
boes, phagedaena, etc. Sarsaparilla, 2S5, Stil- 
lingia, 288, Guaiacum, 2S6, are important 
adjuncts, vehicles, and remedies for the con- 
stitutional disease, the system being unequal to 
further iodine and mercurial treatment. 

TxmijE : 
The various Tainia>fuges, 5S6, Carbolic Acid, 
521, Resorcin, 541, and Salicylic Acid, 534, 
have killed taenia, so that a purgative only was 
necessary. Turpentine, 590, is one of the 
most efficient remedies, although unpleasant in 
the highest degree. Ailanthus, 505, has suc- 
ceeded. 

Tetanus : 
Atropia, 536, injected into the rigid muscles, has 
done good. Strychnia, 320, is alleged to be 
curative in some cases, but doubts are proper. 
Chloral, 419, is certainly a remedy of great 
value. Amyl Nitrite, 490, has been used with 
success ; Sitro-Glycerine, 493, should also 
be fairly tried. Gelsemium, 464, has succeeded, 
and is a promising remedy. Curara, 461, val- 
uable, but uncertain. Bromide of Potassium, 
448, seems to be the most successful remedy. 
Physostigma, 474, has also been used with 
advantage in a number of cases, but its real 
value remains to be determined. Hyoscyamia, 
363, or Duboisia, 365, may be used. Nicotia, 
480, has effected a cure, but its use requires 
caution. Anaesthetics, 409, give temporary re- 
lief. Morphia, 436, injected into the tetanized 
muscles, gives great relief. 

TnEEMrc Fever, or Sunstroke: 
Cold Baths, 63, for the hyperpyrexia. Morphia, 
436, subcutaneously, when convulsions occur, 
or the insensibility and high temperature 
persist. Pilocarpine, ill, should be tried. 
Quinia, 163, Resorcin, 541, and other anti- 
pyretics should be administered subcutane- 
ously. 

Thrombosis and Embolism: 
Ammonia, 202, by the stomach or by intravenous 
injection, to liquefy the obstructing clot. Er- 
got, 333, Quinia, 1C9, and Digitalis, 343, for 
the collateral hypera j mia and cedema. 

Tic-Douloureux. (See Neuralgia.) 
Atropia and Morphia, 354, 356, these alkaloids 
in combination subcutaneously give relief. 
Croton-Chloral, 421, has special effects on the 
fifth nerve. Aconitia, 499, has lately been 
given with good results. Galvanism, 806, 
309, relieves the pain. 

Tinea : 
Boracic Acid, 543, is an excellent topical appli- 
cation. Mercury, 238, corrosive sublimate, as 



an ointment or lotion for tinea tonsurans; 
oleate of mercury in oleic acid, also. Copper, 
252, an ointment of the carbonate. Carbolic 
Acid, 524, applied directly or in glycerine to 
the part affected. Sulphites, 210, in solution, 
also useful. Sulphides, 212, sulphur-batbs, 
faithfully carried on, are curative. 
Tonsillitis : 
Aconite, 497, the tincture of the root, in cases 
accompanied by fever. Guaiacum, 2S6, a full 
dose is said to abort an attack. Ice, 59, held 
against the inflamed part, diminishes the con- 
gestion. Mercury, 233, small doses of calo- 
mel or gray powder reduce the inflammation. 
Quinia, 166, in a full dose at the outset may 
abort an attack. Alum, 271, in powder, solu- 
tion, or whey, does good after the acute symp- 
toms. Tincture of Iodine, 225, injected, will 
gradually diminish the hypertrophied tonsil. 

I Toothache : 

Alum, 271, a solution in nitrous ether is said to 
be effectual. Tannin, 279, dissolved in ether, 
also relieves the pain of a carious tooth. Car- 
bonate of Soda, 191, a saturated solution held 
in the mouth relieves. Opium, 437, or mor- 
phia, a solution of, put In a carious cavity. Oil 
of Cloves, 548, Carbolic Acid, 524, or Resor- 
cin, 541, put in a cavity stops the pain. Xan- 
thoxylum, 292, is a domestic remedy. 

| Torticollis : 

] Galvanism, 305, to the muscles in a state of 
spasm, and faradic applications to the antago- 
nist muscles in a paretic state. Massage, 79, 
Water, 65, hot douche. 
Tuberculosis : 
Grape-Cure, 37, Whey-Cure, 41, Cod-liver Oil, 
99, Iron, 123, valuable in so far as it improves 
nutrition. Iodide of Iron and Manganese, 
123. Chloride of Calcium, 189, apparently 
exercises a real curative influence. 

! Typhlitis : 

Ice, 65, in form of a poultice to the seat of in- 
flammation. Opium, 433, in form of enemata 
of the tincture, or deodorized tincture by the 
Btomach, or morphia subcutaneously, which is 
the most effective. Leeches, 620, to the in- 
flamed region as soon as tenderness is mani- 
fest, and should not be omitted unless the sub- 
ject is feeble. Purgatives, 563, saline, especial- 
ly Epsom salts, alone admissible in typhlitis 
due to impaction of the cmcuui, and positively 
contraindicated in the other forms of the dis- 
ease. 
Typhoid Fever. (See Fever.) 
Aliment, 44, a milk diet, usually most suitable. 
Acids, Mineral, 91, the muriatic, has been 
much employed as a remedy to diminish fever 
and restrain diarrhoea. Iodine, 223, in the 
form of the compound tincture or solution, is 
a remedy of great value— lessens the violence 
and shortens the duration (German "Specific 
Treatment"). Mercury, 235, calomel in ten- 
grain doses for several days during the first 
week or ten days — "specific treatment" — 
shortens the duration and moderates the vio- 
lence of the disease. Carbolic Acid, 522, and 



CLINICAL INDEX. 



G61 



creosote have been cued with great success; 
may be administered with Iodine advantageous- 
ly. The antipyretic and antiseptic treatment 
includes, besides the remedies just named, 
Qui n i<t, 168, in large ■' Baths, 60, 

62, SaHoylic Acid, 586, Resorcin, 541, n,u- 
zoate of Sodium, 648, Arnica, 407, and />/£/;'- 
talis. 841, Nitrate of Stiver, 245, Bismuth, 
l:J4, EouUr's Solution with Tincture of Opi- 
um, 142, are employed to restrain diarrbcen. 

(Tunas : 

Nitric Acid, 91, a powerful cacbarotic, used to de- 
stroy unhealthy tissues aud change the character 
of the surface. Potassa C/ilnrate, 191, in pow- 
der, applied to tho surface, is remarkably benefi- 
cial in cases of unhealthy ulceration, in epithe- 
lioma, etc. Alum, 2T2, dried, is a feeble cscharot- 
ic, and destroys unhealthy granulations. Zinc 
Sulphate, 202, dried, is a valuable caustic, and 
easily managed; tho chloride of zinc is more 
powerful and penetrating, as well as more pain- 
ful. Potassa Fusa, 191, or the milder Vienna 
paste, diffuses widely and destroys deeply. 
Nitrate of Silver, 246, acts superficially, and is 
therefore to be used only when the mildest 
effects arc necessary. Sulphate of Copper, 252, 
is, like silver nitrate, a good application to 
change the character of an indolent ulcer, and to 
form a thin coating under which healing may 
proceed. Iodoform, 225, in powder, dusted 
over tho ulcer, is a capital dressing for syphilitic 
ulcers, irritable sores, and superficial ulcers 
generally ; its odor for these purposes may bo 
covered by thymol, menthol, or euealyptol. 
Carbolic Acid, 524, Salicylic Acid, 589, Bo- 
racic Acid, 543, Resorcin, 541, Thymol, 547, 
are antiseptic, deodorant, and alterative applica- 
tions, of great value in wounds, unhealthy ul- 
ceration, and sloughing phagedena. Galvan- 
ism, 30S, a galvanic couplet, will heal bed-sores 
and unhealthy ulcers. 

Ur.emia : 

Water, 00, the vapor-bath, and hot-water pack, to 
excite the skin and promote free diaphoresis. 
Pilocarpus,41\, Muscaria, 512, and Resorcin, 
541, active diaphoretics, especially the first 
named, but the state of the heart must be care- 
fully watched — a weak or fatty heart being a 
positive contraindication. Digitalis, 342, the 
infusion, an important means of procuring free 
action of the kidneys. Saline, 563, or TTydra- 
gogue Cathartics, 576, are of great importance 
to secure elimination by the intestinal canal, 
and to relieve the blood-pressure. Colchicum, 
288, is an excellent hydragogue and derivative 
in these cases : is best when combined with 
other purgatives. Morph la, 436, by podermat- 
ically. in full doses, is of remarkable value in 
ura?mie convulsions. 

Uric-Acid Diathesis: 
Aliment, 50, the saccharine and starchy foods arc 
proper, but meats and other nitrogenous ma- 
terials objectionable. When excess of uric acid 
is due to deficient oxidation, Nitric Acid, 93, 
especially is of the greatest value ; also muriatic 
and lactic acids. Alkalies, 1S4, 1S5, the potash 



salts, particularly after meals ; also the A Ika- 
line Waters, 195, Air, 77, Massage, 79. 

Chine, Incontinence of: 
Belladonna, 854, tho most important remedy, 
and the alka'oid Atrnjiia is the best prepara- 
tion, a quantity sufficient to induce its physio- 
logical effects being necessary. Ergot, 334, is 
effective when there is a paralytic sphincter, 
and in tho case of diseased prostate. Iodide of 
Iron, 126, the sirup or official pill may be need : 
it is successful in the case of pale, strumous, 
and feeble subjects. Strychnin, 817, may suc- 
ceed when the other remedies fail; must bo 
pushed, and is best adapted to cases character- 
ized by great nerve mobility or weakness. 
When the urine is acid, a proper Diet, 89, and 
Alkalies, 1S5; when alkaline, the Benzoate 
of Ammonia, 545. 

Uterine Colic : 
Aquapuncture, 617, gives surprising relief. 
Morphia and Atropia, 440, subcutaneously. 
Camphor, 809, Gelsemium, 40G, and the ano- 
dynes derivative from alcohol. Chloral, 41 'J, 
Ether, 400, etc. 

Uterus, Fibromata or : 
Ergotin, 336, subcutaneously and by stomach 
and rectum. Chloride of Gold, 241, persist- 
ently used. Chloride of Ammonium, 203, also 
taken for a long time. Saline and alterative 
Waters, 190; those of 8t. Catharine's, Canada, 
of Homburg and Kreutznach, etc. Iodine, 
tincture and glycerites, 226, applied topically. 
Electrolysis, 303. 

Uterus, Hypertrophy of; also, Sub-Involu- 
tion: 

Ergot, 333, 336, fluid extract, and Ergotin, sub- 
cutaneously; must be persistently administered 
for a long time. Electricity, 806, Galvanism — 
an interrupted current, of great value in cases 
of simple enlargement. Iodoform, 220, and 
lodotannin, applied directly to tho uterus. 
promote absorption. Chloride of Gold, 241, 
and Bichloride of Mercury, 224, long contin- 
ued in small doses, do much good. Phytolac- 
ca, 507, Digitalis, 340, and Cimicifuga, 347, 
are very useful in sub-involution. Ipecacu- 
anha, 557, has remarkably good effects in re- 
cent cases of sub-involution, with monorrhagia 
or metrorhagia. 

Uterus, Ulceration of : 
Hydrastis, 157, the fluid extract undiluted, freely 
applied, is a valuable application in cervicitis, 
endocervicitis, ulcer, and eversion. lodotan- 
nin. 22G, iodoform and tannin packed around 
the cervix is a highly useful remedy in ulcer- 
ation and other disorders. Nitrate of Silver, 
247, a long-used and highly esteemed topical 
remedy, but has been much abused. Carbolic 
Acid, 524, pure, on cotton-wrapped probe, is a 
safe and efficient application in endocervicitis, 
endometritis, and ulcerations. Vegetable As- 
tringents, 273, oak, heuchera, hamamelis, ru- 
bus, etc., in the form of strong decoctions, in- 
jections, or fluid extracts, undiluted. Glycerite 
of Tannin, 278, 279, and Glycerine, 623, are 
useful in greater or less degree. 




662 



CLINICAL INDEX. 



Varicocele, and Varicose Veins : 
Ergot, 836, ergotin injected subcutaneously 
alongside the enlarged veins, an effective but 
painful expedient. The injection must not 
enter the veins. Same expedient can be prac- 
tised in the case of any varicose veins in an 
accessible situation. 

Variola : 

Water, 57, Cold Baths for fever, especially hyper- 
pyrexia. Quinia, 169, small doses as a tonic, 
full doses for the suppuration, and antipyretic 
doses if the temperature is high. Ammonia 
Carbonate, 203, if there is manifest depres- 
sion, and especially during the suppuration 
stage. Chloral, 418, is highly useful and ne- 
cessary when there are high temperature, wake- 
fulness, and delirium. Opiimn, 434, for wake- 
fulness, low delirium, and adynamia. Carbolic 
Acid, 523, Besorcin, 541, Salicylic Acid, 535, 
and Benzoate of Sodium, 546, are from the 
theoretical standpoint valuable antiseptics and 
antipyretics. Iodine, 224, tincture, is applied 
to pustules to prevent pitting. Siher Nitrate, 
247, a pointed stick of, is inserted into each 
pustule to abort it and thus prevent the forma- 
tion of a cicatrix. 

Vomiting : 
Alcohol, 395, iced champagne or brandy in small 
quantity frequently, will sometimes arrest vom- 
iting of pregnancy, of sea-sickness, of cholera, 
yellow fever, etc. Chloroform, 491, a few 
drops frequently, will arrest some kinds of 
vomiting, as sea-sickness, passage of gallstones, 
etc. Bromides, 446, are serviceable in cerebral 
vomiting, and in cholera infantum in children, 
and in some cases of reflex vomiting. Chloral, 
417, highly useful in vomiting of sea-sickness, 
cholera, and reflex vomiting. Ipecacuanha, 
555, rarely minute doses, will arrest some ner- 
vous and reflex attacks of vomiting. Arsenic, 
141, drop-doses of Fowler's solution, will stop 
vomiting of irritative dyspepsia, of ulcer, etc. 
Hydrocyanic Acid, 4S6, can be prescribed in 
the vomiting of acute stomach troubles. Pep- 
sin, 84, Milk and Lime-Water, 189, Bismuth, 
134, are proper in the vomiting of indigestion, 
of stomach inflammation, of acidity, and of 
acute intestinal disorders. Calomel, 233, very 
minute doses of, will stop vomiting in cholera 
infantum and in other intestinal disorders in 
children. Oxalate of Cerium, 269, is one of j 
the numerous remedies for the vomiting of 
pregnancy. Nitrite of Amyl and Nitro- 
Glycerine, 493, are said to bo very effective 
in the vomiting of sea-sickness. Alkalies, 1S7, 
especially the effervescent powder. Nux Vom- 
ica, 319, the tincture, will sometimes succeed 
in atonic states. Carbolic Acid, 521, has re- 
markable sedative effects, and will arrest the 
vomiting of acute stomachal and intestinal dis- 
orders; it is advantageously combined with 
bismuth in an emulsion. 

Vomiting of Pregnancy : 
Cerium, 269, is a good remedy if given in full 



doses. Iodine, 219, a drop of the tincture, of 
the compound solution, or of tho compound 
tincture, may succeed when other remedies 
fail. Carbolic Acid, 521, may succeed, but is 
uncertain, and its odor may excite disgust. 
Calumba, 150, a few drops of the tincture may 
quiet the stomach quickly, but it often fails. 
Inglmsin, 81, has been frequently successful ; 
also Pepsin, 82, hut is less useful than the 
former. Nux Vomica, 316, a drop or two of 
the tincture may prove beneficial. Arsenic, 
141, a drop of Fowler's solution, sometimes 
acts most favorably. Hydrocyanic Acid, 486, 
often does good and often fails. Alcohol, 
895, as sparkling wine, may succeed tempora- 
rily. 

Wiiooping-Cough : 
Atropia, 352, is. a good remedy when secretion 
is profuse, and in the spasmodic stage; decided 
physiological effects should be produced to have 
any curative action. Bromides, 451, give relief 
to the spasmodic condition — to the whoop— but 
do not much moderate the violence of the dis- 
ease; Bromide of Camphor, 371, seems to be 
more useful. Chloral, 419, is very useful at 
any stage, but is most serviceable during the 
spasmodic. Castanea, 278, a decoction of the 
leaves, may be taken at pleasure, and with cer- 
tainty of some, although not marked, benefit. 
Nitric Acid, 92, sometimes benefits exceed- 
ingly, but is uncertain. Alum, 271, especially 
when there is a copious bronchial secretion. 
Lobelia, 493, when it acts as a nauseant, is 
most beneficial. Carbolic Acid, 522, by in- 
halation, seems to be a very valuable remec.y. 
Benzoate of Sodium, 546, internally and by 
spray, is reported to be very serviceable. To 
these may be added, Salicylates, Besorcin, 
and other antiseptics. Laetucariurn, 443, the 
sirup, is a useful vehicle for the exhibition of 
other medicines. Asafmtida. 371, a disagree- 
able but useful remedy, and may be given 
freely to infants and young children. Hydro- 
cyanic Acid, 4S6, may be given during the 
sj>asm stage, but it is most efficacious as a 
remedy for the cough kept up by habit after 
the subsidence of the disease, and the cough by 
imitation. 

Worms. (See Parasites.) 
Eucalyptus, 154. Calomel, 234, an excellent 
remedy to expel the round worm, and is best 
administered with santonine. Salicylic Acid, 
534, has been used successfully against taenia. 
Anthelmintics, 5S1. 

Wounds : 
Lister's Method, 525, Water, 66, cold and hot. as 
a dressing for wounds, to arrest haemorrhage, 
and, in form of baths, to depress abnormal heat. 
Alcohol, 391, 396, an excellent antiseptic and 
astringent dressing, and as a remedy in pyrexia. 
Carbolic, 525, Boracic, 543, and Salicylic 
Acids, 539, used under the antiseptic system, 
to disinfect, deodorize, and to change the char- 
acter of wounds. 



THE END. 



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